Using routine blood parameters to anticipate clinical outcomes in invasive aspergillosis.

Abstract

OBJECTIVE\nIn invasive aspergillosis (IA), monitoring response to anti-fungal treatment is challenging. We aimed to explore if routine blood parameters help to anticipate outcomes following IA.\n\n\nMETHODS\nPost-hoc secondary analysis of two multicenter randomized trials was performed. The Global Comparative Aspergillosis Study (GCA, N=123) and the Combination Antifungal Study (CAS, N=251) constituted the discovery and validation cohorts respectively. The outcome measures were response to treatment and survival to 12\xa0weeks. Interval platelet, galactomannan index (GMI) and C-reactive protein (CRP) levels prior and during anti-fungal treatment were analyzed using logistic regression, Kaplan-Meier survival and ROC analyses.\n\n\nRESULTS\nThe 12-week survival was 70.7% and 63.7% for the GCA and CAS cohorts respectively. In the GCA cohort, every 10×109/L platelet count increase at week 2 and 4 improved 12-week survival odds by 6-18% (Odds ratio [OR] 1.06-1.18, 95% confidence interval [CI] 1.02-1.33). Survival odds also improved 13% with every 10 mg/dL CRP drop at week 1 and 2 (OR 0.87, 95% CI 0.78-0.97). In the CAS cohort, week 2 platelet count was also associated with 12-week survival with 10% improved odds for every 10×109/L platelet increase (OR, 1.10, 95% CI, 1.04-1.15). A GMI drop of 0.1 units was additionally found to increase the odds of treatment response by 3% at the baseline of week 0 (OR 0.97, 95% CI, 0.95-0.99). Week 2 platelet and CRP levels performed better than GMI on ROC analyses for survival (area under ROC curve 0.76, 0.87 and 0.67 respectively). A baseline platelet count higher than 30×109/L clearly identified patients with > 75% survival probability.\n\n\nCONCLUSIONS\nHigher serial platelets were associated with overall survival while GMI trends were linked to IA treatment response. Routine and simple laboratory indices may aid follow-up of response in IA patients.