Long-Term Outcomes of Allergic Bronchopulmonary Aspergillosis and Aspergillus Colonization in Children and Adolescents with Cystic Fibrosis
Abstract
:1. Introduction
2. Methods
2.1. Study Population and Design
2.2. Statistical Analysis
2.2.1. Baseline Characteristics: Cross-Sectional Analysis
2.2.2. Longitudinal Analysis
3. Results
3.1. Baseline Characteristics
3.2. Long-Term Outcomes
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Aspergillus Positive | Aspergillus Negative | Total | |
---|---|---|---|
ABPA present | n = 80 | n = 180 | n = 260 |
ABPA absent | n = 183 | n = 1232 | n = 1415 |
Total | n = 263 | n = 1412 | n = 1675 |
Aspergillus Colonization versus No-Aspergillus | ABPA Excluded: Aspergillus Colonization versus No-Aspergillus | ABPA versus No-ABPA | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
No-Aspergillus (n = 1412) | Aspergillus (n = 263) | p-Value | ABPA Excluded: No-Aspergillus (n = 1232) | ABPA Excluded: Aspergillus (n = 183) | p-Value | No-ABPA (n = 1415) | ABPA (n = 260) | p-Value | ||
Male sex, n/total (%) | 717/1412 (50.8%) | 134/263 (51.0%) | p = 0.96 | 615/1232 (49.9%) | 94/183 (51.4%) | p = 0.72 | 709/1415 (50.1%) | 142/260 (54.6%) | p = 0.18 | |
Age in years (2009), mean (SD; range) | 12.0 (2.5; 8–17) | 12.1 (2.5; 8–17) | p = 0.40 | 11.9 (2.5, 8–17) | 12.0 (2.5, 8–16) | p = 0.61 | 11.9 (2.5, 8–17) | 12.3 (2.5, 8–17) | p = 0.05 | |
CFTR genotype, n/total (%) | p = 0.99 | p = 0.64 | p = 0.82 | |||||||
F508del homozygous | 783/1399 (56.0%) | 147/262 (56.1%) | 677/1220 (55.5%) | 106/182 (58.2%) | 783/1402 (55.9%) | 147/259 (56.8%) | ||||
F508del heterozygous | 518/1399 (37.0%) | 96/262 (36.6%) | 456/1220 (37.4%) | 66/182 (36.3%) | 522/1402 (37.2%) | 92/259 (35.5%) | ||||
Other | 98/1399 (7.0%) | 19/262 (7.3%) | 87/1220 (7.1%) | 10/182 (5.5%) | 97/1402 (6.9%) | 20/259 (7.7%) | ||||
ppFEV1 (2010), mean (SD; range) | 78.9 (18.3, 14.9–125.9) (n = 1280) | 71.1 (18.7, 20.9–118.4) (n = 243) | p < 0.00001 | 79.7 (18.2, 14.9–125.9) (n = 1108) | 71.4 (19.3, 20.9–118.4) (n = 170) | p < 0.00001 | 78.6 (18.5, 14.9–125.9) (n = 1278) | 72.5 (18.1, 15.9–116.7) (n = 245) | p < 0.00001 | |
pBMI (2010), mean (SD; range) | 50.0 (29.6, 0–99.9) (n = 1372) | 45.7 (28.2, 0–99.5) (n = 258) | p = 0.03 | 49.7 (29.8, 0–99.9) (n = 1195) | 44.3 (28.3, 0–99.5) (n = 180) | p = 0.02 | 49.0 (29.7, 0–99.9) (n = 1375) | 51.1 (27.9, 0.1–99.2) (n = 255) | p = 0.30 | |
Respiratory disease severity markers | ||||||||||
Oxygen therapy in 2010, n/total (%) | 57/1342 (4.3%) | 15/246 (6.1%) | p = 0.20 | 43/1168 (3.7%) | 13/171 (7.6%) | p = 0.02 | 56/1339 (4.2%) | 16/249 (6.4%) | p = 0.12 | |
Non-invasive ventilation in 2010, n/total (%) | 21/1326 (1.6%) | 2/244 (0.8%) | p = 0.36 | 16/1154 (1.4%) | 1/169 (0.6%) | p = 0.39 | 17/1323 (1.3%) | 6/247 (2.4%) | p = 0.17 | |
Evaluation for lung transplant, n/total (%) | 14/1359 (1.0%) | 3/250 (1.2%) | p = 0.81 | 12/1185 (1.0%) | 3/172 (1.7%) | p = 0.39 | 15/1357 (1.1%) | 2/252 (0.8%) | p = 0.66 | |
Lung transplant, n/total (%) | 10/1412 (0.7%) | 0/263 (0.0%) | p = 0.17 | 10/1232 (0.8%) | 0/183 (0%) | p = 0.22 | 10/1415 (0.7%) | 0/260 (0%) | p = 0.17 |
Aspergillus Colonization versus No-Aspergillus | ABPA Excluded: Aspergillus Colonization versus No-Aspergillus | ABPA versus No-ABPA | |
---|---|---|---|
Clinical characteristics (2010) | |||
ppFEV1, mean difference (95% CI) | −6.3 (−8.8 to −3.9) p < 0.0001 (n = 1513) ** | −6.9 (−9.8 to −4.1) p < 0.0001 (n = 1269) | −5.0 (−7.4 to −2.5) p < 0.0001 (n = 1513) |
pBMI, mean difference (95% CI) | −3.5 (−7.5 to 0.5) p = 0.08 (n = 1617) | −4.5 (−9.2 to 0.2) p = 0.06 (n = 1363) | 2.7 (−1.3 to 6.7) p = 0.18 (n = 1617) |
Bacterial infection (2009–2010) | |||
Pseudomonas aeruginosa, OR (95% CI) | 2.1 (1.6 to 2.7) p < 0.0001 (n = 1661) | 1.7 (1.3 to 2.4) p = 0.001 (n = 1402) | 1.6 (1.2 to 2.1) p = 0.001 (n = 1661) |
Chronic Pseudomonas aeruginosa, OR (95% CI) | 1.3 (0.9 to 1.7) p = 0.12 (n = 1490) | 1.1 (0.8 to 1.6) p = 0.55 (n = 1251) | 1.4 (1.1 to 1.9) p = 0.02 (n = 1490) |
Burkholderia spp., OR (95% CI) | 1.2 (0.6 to 2.5) p = 0.63 (n = 1661) | 1.1 (0.4 to 2.5) p = 0.91 (n = 1402) | 0.6 (0.2 to 1.4) p = 0.23 (n = 1661) |
Stenotrophomonas spp., OR (95% CI) | 3.3 (2.0 to 5.3) p < 0.0001 (n = 1661) | 4.4 (2.5 to 7.8) p < 0.0001 (n = 1402) | 2.4 (1.5 to 4.0) p = 0.001 (n = 1661) |
Staphylococcus aureus, OR (95% CI) | 1.5 (1.2 to 2.0) p = 0.004 (n = 1661) | 1.6 (1.2 to 2.2) p = 0.005 (n = 1402) | 0.9 (0.7 to 1.2) p = 0.56 (n = 1661) |
Haemophilus influenza B, OR (95% CI) | 1.5 (0.9 to 2.3) p = 0.09 (n = 1661) | 1.4 (0.8 to 2.4) p = 0.19 (n = 1402) | 0.7 (0.4 to 1.2) p = 0.23 (n = 1661) |
Non-tuberculous mycobacteria, OR (95% CI) | 4.4 (2.4 to 8.1) p < 0.0001 (n = 1661) | 8.0 (3.8 to 16.9) p < 0.0001 (n = 1402) | 3.0 (1.6 to 5.6) p < 0.0001 (n = 1661) |
Steroid use (2009–2010) | |||
Oral steroids, OR (95% CI) | 1.8 (1.3 to 2.6) p = 0.001 (n = 1661) | 1.0 (0.6 to 1.8) p = 0.89 (n = 1402) | 7.7 (5.6 to 10.6) p < 0.0001 (n = 1661) |
Inhaled steroids, OR (95% CI) | 1.3 (1.0 to 1.7) p = 0.09 (n = 1661) | 1.4 (1.0 to 2.0) p = 0.04 (n = 1402) | 1.2 (0.9 to 1.6) p = 0.2 (n = 1661) |
Antibiotic use (2009–2010) | |||
IV antibiotic requirement (yes/no), OR (95% CI) | 3.7 (2.6 to 5.4) p < 0.0001 (n = 1525) | 3.5 (2.4 to 5.3) p < 0.0001 (n = 1285) | 4.4 (3.0 to 6.4) p < 0.0001 (n = 1525) |
IV antibiotic days, IRR (95% CI) | 1.2 (1.1 to 1.3) p = 0.007 (n = 920) | 1.3 (1.1 to 1.5) p = 0.003 (n = 716) | 1.1 (1.0 to 1.3) p = 0.09 (n = 920) |
Oral antibiotics (chronic), OR (95% CI) | 1.0 (0.8 to 1.4) p = 0.90 (n = 1661) | 1.2 (0.8 to 1.6) p = 0.41 (n = 1402) | 1.0 (0.8 to 1.3) p = 0.90 (n = 1661) |
Oral macrolide (chronic), OR (95% CI) | 1.6 (1.2 to 2.1) p = 0.001 (n = 1661) | 1.5 (1.1 to 2.1) p = 0.02 (n = 1402) | 2.2 (1.7 to 2.9) p < 0.0001 (n = 1661) |
Oral flucloxacillin (chronic), OR (95% CI) | 1.3 (1.0 to 1.6) p = 0.09 (n = 1661) | 1.4 (1.0 to 1.9) p = 0.06 (n = 1402) | 1.0 (0.8 to 1.4) p = 0.84 (n = 1661) |
Nebulised tobramycin, OR (95% CI) | 2.2 (1.6 to 3.0) p < 0.0001 (n = 1661) | 2.1 (1.4 to 3.2) p < 0.0001 (n = 1402) | 2.6 (1.9 to 3.6) p < 0.0001 (n = 1661) |
Nebulised colistin/promixin, OR (95% CI) | 1.9 (1.4 to 2.5) p < 0.0001 (n = 1661) | 1.9 (1.3 to 2.7) p = 0.001 (n = 1402) | 2.3 (1.7 to 3.2) p < 0.0001 (n = 1661) |
Clinical Outcome | Aspergillus Colonization versus No-Aspergillus (n = 1675) | ABPA Excluded (Same Year): Aspergillus Colonization versus No-Aspergillus (n = 1675) | ABPA versus No-ABPA (n = 1675) |
---|---|---|---|
ppFEV1, between group mean difference (95% CI) | −0.01 (−0.2 to 0.2) p = 0.88 (n = 1650) *** | −0.1 (−0.3 to 0.1) p = 0.30 (n = 1611) | −0.5 (−0.6 to −0.3) p < 0.00001 (n = 1650) |
pBMI, between group mean difference (95% CI) | −0.6 (−0.8 to −0.3) p < 0.00001 (n = 1650) | −0.4 (−0.7 to −0.1) p = 0.005 (n = 1611) | −0.8 (−1.1 to −0.6) p < 0.00001 (n = 1650) |
IV antibiotic days (during 12 months prior to annual review), OR (95% CI) | 1.3 (0.9 to 1.9) p = 0.86 (n = 1650) | 1.3 (0.8 to 2.2) p = 0.93 (n = 1609) | 2.2 (1.6 to 3.0) p = 0.67 (n = 1650) |
Lung transplant (in 12 months prior to annual review), OR (95% CI) | 0.7 (0.3 to 1.5) p = 0.34 (n = 1648) | 0.7 (0.3 to 1.6) p = 0.43 (n = 1609) | 0.2 (0.06 to 1.0) p = 0.05 (n = 1648) |
Death (in 12 months prior to annual review), OR (95% CI) | 0.9 (0.5 to 1.6) p = 0.59 (n = 1642) | 0.8 (0.4 to 1.6) p = 0.49 (n = 1587) | 1.4 (0.8 to 2.5) p = 0.26 (n = 1642) |
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Chesshyre, E.; Warren, F.C.; Shore, A.C.; Davies, J.C.; Armstrong-James, D.; Warris, A. Long-Term Outcomes of Allergic Bronchopulmonary Aspergillosis and Aspergillus Colonization in Children and Adolescents with Cystic Fibrosis. J. Fungi 2024, 10, 599. https://doi.org/10.3390/jof10090599
Chesshyre E, Warren FC, Shore AC, Davies JC, Armstrong-James D, Warris A. Long-Term Outcomes of Allergic Bronchopulmonary Aspergillosis and Aspergillus Colonization in Children and Adolescents with Cystic Fibrosis. Journal of Fungi. 2024; 10(9):599. https://doi.org/10.3390/jof10090599
Chicago/Turabian StyleChesshyre, Emily, Fiona C. Warren, Angela C. Shore, Jane C. Davies, Darius Armstrong-James, and Adilia Warris. 2024. "Long-Term Outcomes of Allergic Bronchopulmonary Aspergillosis and Aspergillus Colonization in Children and Adolescents with Cystic Fibrosis" Journal of Fungi 10, no. 9: 599. https://doi.org/10.3390/jof10090599