The impact of the updated EORTC/MSG criteria on the classification of hematological patients with suspected invasive pulmonary aspergillosis
Clin Microbiol Infect. 2022 Mar 3:S1198-743X(22)00103-3. doi: 10.1016/j.cmi.2022.02.026. Online ahead of print.
OBJECTIVES: Our aim was to evaluate the effect of the updated EORTC/MSG 2019 definitions for invasive pulmonary aspergillosis (IPA) on patient classification and the related all-cause 12-week mortality.
METHODS: In this retrospective cohort study from our tertiary care center we reclassified patients with hematological malignancy that underwent bronchoalveolar lavage between 2014-2019 for suspected IPA using the novel EORTC 2019 criteria. We performed ROC curve analysis to define the optimal cut-off for positive PCR and galactomannan and present survival analyses and their possible association with these diagnostic criteria through post-hoc comparisons with Logrank and Cox regression.
RESULTS: From 323 episodes of suspected IPA in 282 patients, 73 were reclassified: 31/73 (42.5%) from possible to probable IPA, 5/73 (6.8%) from EORTC criteria not met to probable IPA and 37/73 (50.7%) from EORTC criteria not met to possible IPA. Probable IPA increased therefore 11.1% (64/323, 19.8% to 100/323, 30.9%), mostly due to positive PCR (31/36, 86.1%). There was no difference in mortality between newly defined possible and probable IPA (Log Rank p=0.950). Mortality was higher in probable cases with lower cycle thresholds (Ct-values) versus higher Ct-values (p=0.004). ROC curve analysis showed an optimal Ct-value cut-off of 36.8 with a sensitivity of 75% (CI 95% 64.9-85.1%) and a specificity of 61.7% (CI 95% 53.5-69.9) for 12-week mortality.
CONCLUSIONS: The new EORTC criteria led to 11.1% more probable IPA diagnoses, mostly due to Aspergillus PCR. Restricting positive PCR to below a certain threshold might improve the discrimination of the new EORTC IPA categories for mortality.