Baseline platelet count and creatinine clearance rate predict the outcome of neutropenia-related invasive aspergillosis

Abstract

Background. Invasive aspergillosis (IA) is a life-threatening infection for immunocompromised patients. Improvement in IA outcome has been hampered by lack of early prognostic factors, namely, those available before starting chemotherapy (baseline) or early in the course of IA (nonbaseline). We hypothesized that prognostic factors can be identified before chemotherapy, ≤7 days from the first positive serum Aspergillus galactomannan index (s-GMI).Methods.We analyzed 98 patients with multiple myeloma who developed neutropenia-related IA and had a positive s-GMI. Three response criteria were used: kinetics of s-GMI, European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions, and 6-week survival. Baseline and nonbaseline variables were analyzed separately.Results.Independent response predictors at baseline were a platelet count ≥65,000 platelets/mm 3 (odds ratio [OR], 1.009; 95 confidence interval [CI], 1.001-1.017; P =. 03) by s-GMI kinetics, and a platelet count ≥65,000 platelets/mm 3 (OR, 1.009; 95 CI, 1.002-1.017; P =. 01) and a creatinine clearance rate ≥53 mL/min (OR, 1.024; 95 CI, 1.006-1.042; P =. 009) by EORTC/MSG criteria, with response rates of 83 and 28 when both variables were above or below these cutoffs, respectively (P