AUTHOR=Wu Yi-xing , Zuo Yi-hui , Cheng Qi-jian , Huang Yi , Bao Zhi-yao , Jin Xiao-yan , Gao Xi-wen , Tu Chun-lin , Hu Wei-ping , Hang Jing-qing , Wang Wei-qin , Zhang Feng-ying , Zhang Jing 

TITLE=Respiratory Aspergillus Colonization Was Associated With Relapse of Acute Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Analysis of Data From A Retrospective Cohort Study

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.640289

DOI=10.3389/fmed.2021.640289

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Patients with chronic obstructive pulmonary disease (COPD) are more susceptible to <italic>Aspergillus</italic> colonization or infection. Several studies have demonstrated that invasive pulmonary Aspergillosis (IPA) and <italic>Aspergillus</italic> hypersensitivity (AH) have a detrimental effect on COPD. However, it remains to be clarified whether <italic>Aspergillus</italic> colonization is associated with acute exacerbation of COPD (AECOPD). This study aimed to explore the impact of <italic>Aspergillus</italic> colonization in the lower respiratory tract on AECOPD.</p><p><bold>Method:</bold> Patients with <italic>Aspergillus</italic> colonization were identified from a retrospective cohort of hospitalized AECOPD from 2011 to 2016 in eight centers in Shanghai, China. The demographic information, conditions of the stable stage, clinical characteristics during hospitalization, and 1-year follow-up information after discharge were collected and compared to participants without fungi colonization.</p><p><bold>Result:</bold> Twenty-six hospitalized AECOPD patients with <italic>Aspergillus</italic> colonization and 72 controls were included in the final analysis after excluding patients with other fungi isolation and matching. The rates of recurrence of acute exacerbation within 90 days and 180 days after discharge in the patients with <italic>Aspergillus</italic> colonization were both significantly higher than that in the fungi negative patients (90 days: 19.2 vs. 4.2%, <italic>p</italic> = 0.029; 180 days: 23.1 vs. 4.2%, <italic>p</italic> = 0.010), and the all-cause mortality within 1 year was also higher (11.5 vs. 0.0%, <italic>p</italic> = 0.017). Multivariate logistic regression analysis showed that <italic>Aspergillus</italic> colonization was an independent risk factor for the recurrence of acute exacerbation within 90 days and 180 days (90 days: OR = 8.661, 95% CI: 1.496-50.159, <italic>p</italic> = 0.016; 180 days: OR =10.723, 95% CI: 1.936-59.394, <italic>p</italic> = 0.007).</p><p><bold>Conclusion:</bold><italic>Aspergillus</italic> colonization may predict poor prognosis of AECOPD while leading to an increased risk of recurrent AECOPD in a short period.</p>