Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Hatzl, S; Geiger, C; Kriegl, L; Scholz, L; Reisinger, AC; Kreuzer, P; Fruhwald, S; Wölfler, A; Reinisch, A; von, Lewinski, D; Schilcher, G; Hoenigl, M; Eller, P; Krause, R.
Performance of diagnostic algorithms in patients with invasive pulmonary aspergillosis.
Clin Infect Dis. 2024;
Doi: 10.1093/cid/ciae633
Web of Science
PubMed
FullText
FullText_MUG
- Leading authors Med Uni Graz
- Hatzl Stefan
- Krause Robert
- Co-authors Med Uni Graz
- Eller Philipp
- Fruhwald Sonja
- Hönigl Martin
- Kreuzer Philipp
- Kriegl Lisa
- Reinisch Andreas
- Reisinger Alexander Christian
- Schilcher Gernot
- Scholz Laura
- von Lewinski Dirk
- Wölfler Albert
- Altmetrics:
- Dimensions Citations:
- Plum Analytics:
- Scite (citation analytics):
- Abstract:
- BACKGROUND: Invasive pulmonary aspergillosis (IPA), once limited to immunocompromised patients, is now a severe complication in critically ill ICU patients without classic risk factors. Due to the difficulty of obtaining histological evidence, its diagnosis relies on poorly tested algorithms in real-world settings. METHODS: We conducted a retrospective multicenter (n=9) cohort study including 202 patients with IPA. Patients were classified using a multistep process based on the European Organization for the Research and Treatment of Cancer/Mycosis Study Group (EORTC-MSG), Invasive-Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU), Aspergillus ICU (Asp-ICU), and Asp-ICU with biomarkers (Asp-ICU-BM) criteria. We then evaluated the predictive performance of these criteria against the clinical cohort and histologically proven cases. RESULTS: Among 202 patients, 78 had EORTC-MSG host factors and were classified accordingly, with the EORTC-MSG criteria achieving 100% agreement in identifying clinical and histologically proven cases. In 112 ICU patients without EORTC-MSG host factors, overall agreement was 53% for FUNDICU, 4% for Asp-ICU, and 26% for Asp-ICU-BM compared to the clinical cohort. Validation against histologically proven cases showed FUNDICU had 44% sensitivity and 75% specificity, Asp-ICU 6% sensitivity and 100% specificity, and Asp-ICU-BM 28% sensitivity and 63% specificity. Adding acute respiratory distress syndrome (ARDS) and post-cardiac surgery to the FUNDICU criteria improved sensitivity to 97% with a specificity of 63%. The remaining 12 patients lacked EORTC-MSG host factors and were not in the ICU, highlighting a novel classification system. CONCLUSION: EORTC-MSG and FUNDICU IPA classification systems are useful for the assignment of most patients with IPA. Incorporating post-operative complications after cardiac surgery and ARDS enhanced the diagnostic accuracy of FUNDICU.
- Find related publications in this database (Keywords)
- invasive pulmonary aspergillosis
- ICU
- host factors
- classification
- IPA