Predictors of Mortality in Chronic Pulmonary Aspergillosis

Chronic pulmonary aspergillosis (CPA) is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. Contemporary series suggest 50 to 85% five year mortality, with few prognostic factors identified. A cohort of 387 CPA patients referred to the UK’s National Aspergillosis Centre from 1992 to June 2012 was studied until June 2015. The impact of objective and subjective variables including age, sex, previous pulmonary conditions, dyspnea score, quality of life, serum albumin and CRP and radiological appearances were assessed using Kaplan-Meier curves, Log-Rank tests and Cox proportional hazards modeling. In samples of patients, retrospective review of likely onset of CPA to referral and cause of death was also investigated. Survival was 86%, 62% and 47% at one, five and 10 years. Increased mortality was associated with non-tuberculous mycobacterial infection (NTM) (HR 2.07 (1.22-3.52), p<0.001), and COPD (HR 1.57 (1.05-2.36), p=0.029) as well as higher age (HR 1.053 (1.03-1.07)/year increase, p<0.001), lower albumin (HR 0.92 (0.87 to 0.96) /g/L), lower activity (HR 1.021 (1.01-1.03) /point increase in St. George’s Respiratory Questionnaire Activity Domain, p<0.001) and having one and especially bilateral aspergillomas (p <0.001). Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis.