In hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), use of a simple risk-predictive model for invasive pulmonary aspergillosis provided earlier, more accurate information regarding an individual’s risk for this complication, according to the results of a study published in Respiratory Research.

Researchers conducted a retrospective, single-center cohort study was conducted in patients with AECOPD who were admitted to Jinling Hospital in Nanjing, China. The study authors sought to develop and validate a nonogram of a risk-predictive model for rapid recognition and appropriate empirical antifungal treatment in patients with severe AECOPD, particularly in hospitals with limited resources. Patients with AECOPD who required hospitalization between January 2012 and December 2017 were included in the study.

The diagnosis of AECOPD was based on guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Proven invasive pulmonary aspergillosis, which was diagnosed via the presence of mycelium and related tissue damage upon histopathologic examination of lung tissue, was accompanied by any of the following: isolation of Aspergillus in lower respiratory tract samples, positive serum Aspergillus antigen or antibody, or direct molecular immunology or culture methods reported that the mycelium was Aspergillus filaments. Data from all eligible patients with AECOPD were obtained regarding potential risk factors for invasive pulmonary aspergillosis. 

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A total of 880 inpatients with AECOPD were randomly divided into the training set (n=616 [70%]) or the validation set (n=264 [30%]). Results of the study showed that the incidence of invasive pulmonary aspergillosis  in hospitalized patients with AECOPD was 9.6% (59 of 616) in the training set and 9.1% (24 of 264) in the validation set.

According to the model, independent risk factors associated with invasive pulmonary aspergillosis included lung function GOLD 3-4, use of broad-spectrum antibiotics for more than 10 days in the last month, use of oral or intravenous corticosteroids (prednisone equivalent) of ≥265 mg in the last 3 months, invasive ventilation at hospital admission, serum albumin of <30 g/L, and history of AECOPD.

The c-statistic of the nomogram model was 0.8 (95% CI, 0.74-0.86) in the training set and 0.79 (95% CI, 0.68-0.90) in the validation set. The calibration belt suggested that the risk-predictive model had strong concordance performance in both the training and the validation data sets.

The researchers concluded that additional studies are warranted to validate application of the nomogram in clinical practice and determine whether invasive pulmonary aspergillosis can be more accurately predicted.


Gu Y, Ye X, Liu Y, et al. A risk-predictive model for invasive pulmonary aspergillosis in patients with acute exacerbation of chronic obstructive pulmonary disease. Respir Res. 2021;22(1):176. doi:10.1186/s12931-021-01771-3