| Affiliation: | 1.Department I of Internal Medicine,University Hospital of Cologne,Cologne,Germany;2.German Centre for Infection Research, Partner Site Bonn-Cologne,Cologne,Germany;3.Diagnostic and Interventional Radiology with Nuclear Medicine,Chest Clinic at University Hospital Heidelberg,Heidelberg,Germany;4.Department of Diagnostic and Interventional Radiology,University Hospital of Heidelberg,Heidelberg,Germany;5.Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL),Heidelberg,Germany;6.Infectious Disease Research Program, Department of Paediatric Haematology/Oncology,University Children’s Hospital,Muenster,Germany;7.Department of Medicine A, Haematology/Oncology,University of Muenster,Muenster,Germany;8.Centre for Clinical Trials, ZKS Muenster (BMBF 01KN1105),University Hospital Muenster,Muenster,Germany;9.Clinical Trials Center Cologne, ZKS Koeln (BMBF 01KN1106),University of Cologne,Cologne,Germany;10.Center for Integrated Oncology CIO K?lnBonn,Cologne,Germany;11.Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD),University of Cologne,Cologne,Germany |
| Abstract: | BackgroundSerial chest CT is the standard of care to establish treatment success in invasive pulmonary aspergillosis (IPA). Data are lacking how response should be defined.MethodsDigital CT images from a clinical trial on treatment of IPA were re-evaluated and compared with available biomarkers. Total volume of pneumonia was added up after manual measurement of each lesion, followed by statistical analysis.ResultsOne-hundred and ninety CT scans and 309 follow-up datasets from 40 patients were available for analysis. Thirty-one were neutropenic. Baseline galactomannan (OR 4.06, 95%CI: 1.08–15.31) and lesion volume (OR 3.14, 95%CI: 0.73–13.52) were predictive of death. Lesion volume at d7 and trend between d7 and d14 were strong predictors of death (OR 20.01, 95%CI: 1.42–282.00 and OR 15.97, 95%CI: 1.62–157.32) and treatment being rated as unsuccessful (OR 4.75, 95%CI: 0.94–24.05 and OR 40.69, 95%CI: 2.55–649.03), which was confirmed by a Cox proportional hazards model using time-dependent covariates.ConclusionAny increase in CT lesion volume between day 7 and day 14 was a sensitive marker of a lethal outcome (>50%), supporting a CT rescan each one and 2 weeks after initial detection of IPA. The predictive value exceeded all other biomarkers. Further CT follow-up after response at day 14 was of low additional value. Key Points ? CT evaluation offers good prediction of outcome for invasive pulmonary aspergillosis.? Predictive capability exceeds galactomannan, blood counts, and lesion count.? Any progression between day 7 and day 14 constitutes a high-risk scenario. |
