Logistic regression analysis of factors affecting COPD patients with combined invasive pulmonary aspergillosis and preventive countermeasures

MIAN Ruiqing; ZHANG Minghui; QIAO Lijiao; WANG Honghong; WANG Jing

doi:10.3969/j.issn.1673-3827.2025.06.009

Abstract：Objective To investigate the influencing factors of combined invasive pulmonary aspergillosis(IPA)in patients with chronic obstructive pulmonary disease(COPD),in order to guide the development of clinically rational preventive countermeasures.Methods The clinical data of 53 patients with COPD combined with IPA admitted to General Hospital of Ningxia Medical University from January 2020 to November 2024 were retrospectively collected as the study group,and the clinical data of 53 patients with COPD not combined with IPA were collected as the control group.The microbiological examination results of the patients in the study group were analyzed,the general conditions,laboratory examination data,clinical manifestations and chest CT manifestations of the two groups were compared,and the risk factors of IPA in COPD patients were analyzed by multifactorial logistic regression.Results Among the 53 patients with COPD combined with IPA,Aspergillus filaments was detected in one case by lung tissue puncture pathology and the diagnosis was confirmed by positive microbiological culture of Aspergillus fumigatus.The remaining 52 cases were diagnosed clinically.Microbiological culture of 53 cases of COPD combined with IPA revealed 53 fungal strains,including 35 isolates of Aspergillus fumigatus(66.04%),6 isolates of Aspergillus niger(11.32%),6 isolates of Aspergillus flavus(11.32%),4 isolates of Aspergillus oryzae(7.55%)and 2 isolates of Aspergillus terreus(3.77%).The study group had a higher percentage of combination of diabetes mellitus,having hypoalbuminemia,systemic use of hormones,using≥3 types of antimicrobial drugs,using antimicrobial drugs for≥14 d,having invasive operations,having a hospitalization time of≥14 d,fever,hemoptysis,and corona sign,nodular shadow,and cavitation(P＜0.05).Multifactorial logistic regression analysis showed that the combination of diabetes mellitus(OR=3.080),having hypoalbuminemia(OR=2.630),systemic use of hormones(OR=3.108),using≥3 types of antimicrobial drugs(OR=2.210),using antimicrobial drugs for≥14 d(OR=1.929),having invasive operation(OR=2.421),and hospitalization time≥14 d(OR=2.793)were all risk factors for comorbid IPA in patients with COPD(P＜0.05).Conclusion The main causative organism in patients with COPD combined with IPA was Aspergillus fumigatus,and its occurrence were closely related to the combination of diabetes mellitus,having hypoalbuminemia,systemic use of hormones,using≥3 types of antimicrobial drugs,using antimicrobial drugs for≥14 d,having invasive operations,having a hospitalization time of≥14 d.Clinics could formulate reasonable preventive countermeasures accordingly to reduce the risk of IPA in patients with COPD.