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Invasive aspergillosis, although rare, increases hospital mortality, readmission rates
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A reassessment of the epidemiology and outcomes of invasive aspergillosis in hospitalized patients in the United States found that the illness remains rare — even among high-risk groups — but is associated with a nearly 40% increase in the odds of hospital readmission within 1 month and a fourfold increase in hospital mortality.
Patients with invasive aspergillosis (IA) spend an extra 6 days in the hospital at a cost of $15,000 per admission, although both figures — as well as the crude mortality for patients with IA — have fallen, according to Marya D. Zilberberg, MD, MPH, founder and president of EviMed Research Group, and colleagues.
“Although IA occurs infrequently among immunocompetent individuals, it remains a major issue in the care of patients who have undergone either stem cell or solid organ transplantation, with the prevalence over 10% in select populations,” they wrote in Clinical Infectious Diseases.
But Zilberberg and colleagues said “broadly generalizable” data on the current burden from IA hospitalizations in the U.S. are lacking and old estimates need to be reassessed.
To provide an update, they searched a national inpatient database from 2010 to 2013 for patients at high risk for IA, including stem cell or solid organ transplant recipients, patients with a critical illness or those who underwent major surgery or who were mildly to severely immunocompromised. The primary endpoint was the hospital mortality rate among patients with IA. They also analyzed length of stay (LOS) and hospital costs as secondary outcomes.
Among more than 66.6 million discharged patients included in their analysis, just 0.2% had a diagnosis of IA, Zilberberg and colleagues reported. IA was associated with an increased readmission rate within 30 days (OR = 1.39; 95% CI, 1.34-1.45) and the hospital mortality rate among patients with an IA diagnosis was 14.1% compared with 3.4% among non-IA patients.
The analysis showed that IA hospitalizations have quadrupled since 1996 to nearly 40,000 annually — probably due to improved diagnostics and increases in the use of immunosuppressive therapies and organ transplantation, Zilberberg and colleagues said. But crude mortality has declined from 19% to 14% during the same time period, with the average excess LOS and related costs also falling from 12 to 6 days and $51,000 to $15,000 per admission, respectively. Zilberberg and colleagues estimated that excess costs attributable to IA may reach $600 million a year — same as a 2000 estimate.
“That is, although the incidence of IA has increased, outcomes for these patients seem to have improved substantially,” Zilberberg and colleagues wrote. “Consequently, the net total economic burden has probably fallen when one incorporates the impact of health care inflation, because our findings are reported in nominal dollars.”
The researchers said their analysis showed that IA remains rare, even in the presence of a high-risk condition.
“At the same time, IA adds substantially not only to the risk of death, but also to the expenses of hospitalization,” they wrote. – by Gerard Gallagher
Disclosures: Zilberberg reports receiving grants from EviMed Research Group and Astellas Pharma during the conduct of the study, personal fees from Paratek, Tetraphase, Melinta, Achaogen, Pfizer, Shionogi and Cleveland Clinic, grants from Merck and The Medicines Company, and stock ownership from Johnson & Johnson, outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.
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