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. 2018 Aug 16;67(5):727-735.
doi: 10.1093/cid/ciy181.

Epidemiology and Outcomes of Hospitalizations With Invasive Aspergillosis in the United States, 2009-2013

Marya D Zilberberg  1 , Brian H Nathanson  2 , Rachel Harrington  3 , James R Spalding  3 , Andrew F Shorr  4
Affiliations

Epidemiology and Outcomes of Hospitalizations With Invasive Aspergillosis in the United States, 2009-2013

Marya D Zilberberg et al. Clin Infect Dis. .

Abstract

Background: Though invasive aspergillosis (IA) complicates care of up to 13% of patients with immunocompromise, little is known about its morbidity and mortality burden in the United States.

Methods: We analyzed the Health Care Utilization Project's data from the Agency for Healthcare Research and Quality for 2009-2013. Among subjects with high-risk conditions for IA, IA was identified via International Classification of Diseases, Ninth Revision, Clinical Modification codes 117.3, 117.9, and 484.6. We compared characteristics and outcomes between those with (IA) and without IA (non-IA). Using propensity score matching, we calculated the IA-associated excess mortality and 30-day readmission rates, length of stay, and costs.

Results: Of the 66634683 discharged patients meeting study inclusion criteria, 154888 (0.2%) had a diagnosis of IA. The most common high-risk conditions were major surgery (50.1%) in the non-IA and critical illness (41.0%) in the IA group. After propensity score matching, both mortality (odds ratio, 1.43; 95% confidence interval, 1.36-1.51) and 30-day readmission (1.39; 1.34-1.45) rates were higher in the IA group. IA was associated with 6.0 (95% confidence interval, 5.7-6.4) excess days in the hospital and $15542 ($13869-$17215) in excess costs per hospitalization.

Conclusions: Although rare even among high-risk groups, IA is associated with increased hospital mortality and 30-day readmission rates, excess duration of hospitalization, and costs. Given nearly 40000 annual admissions for IA in the United States, the aggregate IA-attributable excess costs may reach $600 million annually.

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Figures

Figure 1.
Figure 1.
Study enrollment flow chart. High-risk conditions include stem cell and solid organ transplants, severe immunocompromise (leukemia/lymphoma, chemotherapy, other immune disorders, and long-term steroid use), critical illness (trauma, septicemia, necrotizing fasciitis, intracranial hemorrhage, and mechanical ventilation for ≥96 hours), mild-to- moderate immunocompromise (end-stage renal disease or hemodialysis, lupus, malignant solid tumors, diabetic ketoacidosis, and blood disorders), major surgery, and other conditions (pneumonia, chronic obstructive pulmonary disease, and human immunodeficiency virus infection). Abbreviations: HCUP, Health Care Utilization Project; IA, invasive aspergillosis; NIS, National Inpatient Sample.
Figure 2.
Figure 2.
High-risk conditions in the comparator groups in the National Inpatient Sample. The invasive aspergillosis (IA) and non-IA groups differed significantly (P < .001). The “Other” designation includes pneumonia, chronic obstructive pulmonary disease, and human immunodeficiency virus infection.
See this image and copyright information in PMC

Comment in

  • Reply to van de Peppel and de Boer.
    Zilberberg MD, Shorr AF. Zilberberg MD, et al. Clin Infect Dis. 2019 Jan 18;68(3):532. doi: 10.1093/cid/ciy699. Clin Infect Dis. 2019. PMID: 30165475 No abstract available.
  • The Complex Case of Aspergillus and Mortality.
    van de Peppel RJ, de Boer MGJ. van de Peppel RJ, et al. Clin Infect Dis. 2019 Jan 18;68(3):531-532. doi: 10.1093/cid/ciy698. Clin Infect Dis. 2019. PMID: 30165683 No abstract available.

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