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The following is a summary of “Mortality in chronic pulmonary aspergillosis: a systematic review and individual patient data meta-analysis,” published in the November 2024 issue of Infectious Disease by Sengupta et al.
Researchers conducted a retrospective study to assess mortality rates and identify predictors in chronic pulmonary aspergillosis (CPA) despite antifungal treatment.
They performed a systematic literature search across MEDLINE (PubMed), Scopus, Embase, and Web of Science to identify studies in English reporting mortality in CPA from database inception to August 15, 2023. Clinical studies, observational studies, controlled trials, and abstracts were included, while case reports, animal studies, letters, news, and literature reviews were excluded. Authors of studies published since 2016 were reached out for anonymized individual patient data (IPD), and summary estimates were extracted. Subgroup analysis was conducted on 1-year and 5-year mortality, data source, study design, risk of bias, country, Human Development Index, age groups, and underlying lung disease. Random-effects meta-analyses were used to estimate pooled mortality rates, and meta-regression was performed to explore heterogeneity sources. A one-stage meta-analysis with a stratified Cox proportional hazards model assessed univariable hazards for mortality, adjusting for age, sex, type of CPA, treatment, and pulmonary comorbidities.
The results showed 79 studies with 8,778 patients were included, and 15 studies with 1859 patients were part of the IPD meta-analysis. Pooled mortality was 27% overall (95% CI 22–32; I2 = 95.4%), 15% at 1 year (95% CI 11–19; I2 = 91.6%), and 32% at 5 years (95% CI 25–39; I2 = 94.3%). Mortality for patients with CPA and pulmonary tuberculosis as the main predisposing condition was 25% (95% CI 16–35; I2 = 87.5%; 20 studies), while for those with chronic obstructive pulmonary disease, it was 35% (95% CI 22–49; I2 = 89.7%; 14 studies). Mortality in patients who underwent surgical resection was low at 3% (95% CI 2–4). In multivariable analysis, pulmonary tuberculosis had the lowest mortality hazard, while malignancy, subacute invasive pulmonary aspergillosis, and chronic cavitary pulmonary aspergillosis subtypes were linked to higher mortality. The mortality hazard increased by 25% per decade of age (adjusted hazard ratio 1.25 [95% CI 1.14–1.36], P <0.0001).
Investigators concluded the CPA was linked to high mortality, with advancing age, CPA subtype, and comorbidities serving as key predictors.
Source: thelancet.com/journals/laninf/article/PIIS1473-3099(24)00567-X/fulltext
