The Difference in All-Cause Mortality Between Allergic Bronchopulmonary Aspergillosis with and without Chronic Obstructive Pulmonary Disease

Figures & data

Table 1 Comparison of Characteristics Between Patients Who Had ABPA with or Without COPD

	All Patients (n=61)	With COPD		P value
		Yes (n=10)	No (n=51)
Age, years	58.63±17.01	76.00±9.64	52.78±16.77	<0.001
Male	31 (50.82%)	10(100.00%)	21(41.18%)	0.002
Smokers	21(34.43%)	10(100.00%)	11(21.57%)	<0.001
Pack-years of smoking	0 (0–12.5)	0 (0–0)	32.5 (27.5–55.13)	<0.001
Dead	11(18.03%)	7(70.00%)	4(7.84%)	<0.001
Duration of ABPA, in months	249.00(85.00–592.00)	321(76.50–603.50)	165.00(85.00–592.00)	0.585
BMI (kg/m^2)	22.61±3.53	20.61±2.59	23.07±3.48	0.040
Peripheral blood cells
Leukocyte, ×10^9/L	9.12±3.83	9.40±2.54	8.89±4.00	0.703
Neutrophil, ×10^9/L	5.63±3.10	7.45±2.64	5.12±3.05	0.029
Neutrophil, %	58.00±18.27	69.04±24.5	55.08±15.73	0.026
Eosinophil, ×10^9/L	0.49(0.07–0.90)	0.09(0.03–0.65)	0.62(0.24–0.94)	0.026
Eosinophil, %	6.90(0.9–13.00)	1.45(0.23–6.85)	9.60(2.61–13.50)	0.006
Inflammatory indicator
NLR	2.65(1.49–6.65)	8.68(4.33–16.66)	1.90(1.43–5.86)	<0.001
CRP, mg/L	5.97(1.90–18.50)	15.1(7.91–100.84)	3.94(1.00–15.40)	0.011
ESR, mm/h	17.00(7.0–29.00)	20.5(7.50–43.25)	17(6.00–28.00)	0.477
Immunological tests
Total IgE, IU/mL	2248.00(1256.00–2500.00)	2213.50(1260.50–2500.00)	2248.00(1256.00–2500.00)	0.968
Sp-IgE, kUA/L	2.82(0.68–12.80)	2.56(1.10–6.83)	2.82(0.53–13.30)	0.579
Comorbidity
Asthma	52(85.25%)	4(40.00%)	48(94.12%)	<0.001
Allergic rhinitis	32(52.46%)	1(10.00%)	31(60.78%)	0.009
Spirometry
FEV1/FVC	59.45±15.80	46.94±7.79	63.08±15.90	<0.001
FEV1/pred	57.79±27.06	37.17±8.59	64.82±26.25	<0.001
PEF, L/s	3.79(2.89–5.93)	2.80(2.57–3.58)	4.70(3.21–6.55)	0.012
PEF, %	57.50(41.00–87.00)	40.3(32.50–47.15)	73.8(49.5–95.30)	0.001
DLCO, %	71.94±22.68	56.56±14.66	75.68±22.74	0.021
DLCO/VA, mmol/min/kPa/L	1.29(1.05–1.55)	0.85(0.64–1.04)	1.47(1.24–1.60)	<0.001
Arterial blood gas
PaO2, mmHg	76.05±12.35	73.00±11.89	76.33±12.71	0.461
PaCO2, mmHg	41.00(39.00–44.00)	40.00(40.00–4.75)	41.00(38.00–43.00)	0.566
SaO2, %	96.00 (94.00–97.00)	95.00(91.50–96.75)	96.00(94.00–97.00)	0.182
Treatment
Glucocorticoids	54(88.52%)	8(80.00%)	46(90.20%)	0.702
Antifungal Drugs	43(70.49%)	6(60.00%)	35(68.63%)	0.870

Abbreviations: BMI, Body mass index; CRP, C-reactive protein; DLCO, Diffusion capacity of carbon monoxide; VA, Alveolar volume; ESR, Erythrocyte sedimentation rate; FEV₁/FVC, Forced expiratory volume in one second (FEV₁)/forced vital capacity (FVC); FEV₁/pred, Percentage of FEV₁ predicted; IgE, Immunoglobulin E; NLR, Neutrophil-to-lymphocyte ratio; PEF, Peak expiratory flow percentage; PaO₂, Partial arterial oxygen pressure; PaCO₂, Partial arterial pressure of carbon dioxide; SaO_2, Oxygen saturation; Sp-IgE, Aspergillus fumigatus specific IgE.

Figure 1 Survival curves for all-cause mortality in all patients with ABPA.

Table 2 Results of the Kaplan-Meier Analysis for Motality of ABPA

Variable		Log Rank Test
		Mean Survival Time (Months)	χ^2	P value
COPD	Yes	37.00	34.94	<0.001
	No	129.98
Age	≥ 60 years	80.84	14.75	<0.001
	< 60 years	137.31
Gender	Male	91.85	6.73	0.009
	Female	134.00
Smokers	Yes	72.21	15.77	<0.001
	No	134.63
Neutrophil	≥4.4 × 10^9/L	92.00	7.06	0.008
	<4.4 × 10^9/L	134.78
CRP	≥11.56mg/L	73.53	13.83	<0.001
	<11.56mg/L	133.33
NLR	≥3.76	76.64	7.44	0.006
	<3.76	131.52
PEF	≥2.91L/s	120.65	9.03	0.003
	<2.91L/s	71.06
PEF%	≥41.55%	120.87	10.16	0.001
	<41.55%	68.25
DLCO%	≥72.85%	-	7.97	0.005
	<72.85%	82.96
DLCO/VA	≥1.235mmol/min/kPa/L	131.00	18.35	<0.001
	<1.235mmol/min/kPa/L	60.04

Abbreviations: COPD, Chronic Obstructive Pulmonary Disease; CRP, C-reactive protein; DLCO, Diffusion capacity of carbon monoxide; VA, Alveolar volume; NLR, Neutrophil-to-lymphocyte ratio; PEF, Peak expiratory flow percentage.

Figure 2 Survival curves for all-cause mortality in patients of different subgroups.

Table 3 Comparison of Clinical Characteristics of All Patients with ABPA Between the Death and Survival Groups

	Survival		P value
	Yes (n=50)	No (n=11)
Age, years	52.98±17.37	73.00±10.02	0.001
Male	22(44.00%)	9(81.82%)	0.023
Smokers	12(24.00%)	9(81.82%)	0.001
Pack-years of smoking	0(0–0)	30(15–50)	<0.001
Duration of ABPA, in months	262.50(89.00–610.75)	165.00(49.00–517.00)	0.800
BMI (kg/m^2)	23.00±3.54	21.13±2.73	0.107
Peripheral blood cells
Leukocyte, × 10^9/L	8.52±3.33	10.91±4.98	0.058
Neutrophil, × 10^9/L	5.09±3.01	7.33±2.85	0.030
Neutrophil, %	56.68±16.52	61.23±24.4	0.461
Eosinophil, × 10^9/L	0.48(0.09–0.80)	0.70(0.06–1.75)	0.968
Eosinophil, %	7.50(1.35–11.24)	6.90(0.60–15.85)	0.750
Inflammatory indicator
NLR	1.97(1.41–5.88)	6.50(2.96–14.28)	0.002
CRP, mg/L	3.03(0.98–10.96)	48.16(9.72–126.7)	<0.001
ESR, mm/h	13.50(5.00–26.50)	28.00(15.00–67.50)	0.030
Immunological tests
Total IgE, IU/mL	2324.50(1276.25–2500.00)	1927.00(1101.00–2500.00)	0.526
Sp-IgE, kUA/L	2.22(0.55–14.03)	3.5(0.73–6.62)	0.219
Comorbidity
Asthma	45(90.00%)	7(63.64%)	0.078
COPD	3(6.00%)	7(63.64%)	<0.001
Allergic rhinitis	30(60.00%)	2(18.18%)	0.012
Spirometry
FEV1/FVC	62.62±16.12	53.00±14.2	0.077
FEV1/pred	63.11±25.60	48.07±26.27	0.095
PEF, L/s	4.68(3.31–6.53)	2.71(2.35–3.67)	0.027
PEF, %	73.50(48.83–94.48)	39.6(30.55–56.90)	0.024
DLCO, %	76.41±23.51	57.57±10.62	0.014
DLCO/VA, mmol/min/kPa/L	1.48(1.24–1.61)	1.04(0.78–1.15)	<0.001
Arterial blood gas
PaO2, mmHg	76.46±13.15	72.91±10.14	0.417
PaCO2, mmHg	41.50(38.75–44.25)	40.00(39.00–42.5)	0.326
SaO2, %	96.00(94.00–97.00)	95.00(93.50–97.00)	0.567
Treatment
Glucocorticoids	43(86.00%)	11(100.00%)	0.426
Antifungal Drugs	34(68.00%)	7(63.64%)	1.000

Abbreviations: BMI, Body mass index; CRP, C-reactive protein; DLCO, Diffusion capacity of carbon monoxide; VA, Alveolar volume; ESR, Erythrocyte sedimentation rate; FEV₁/FVC, Forced expiratory volume in one second (FEV₁)/forced vital capacity (FVC); FEV₁/pred, Percentage of FEV₁ predicted; IgE, Immunoglobulin E; NLR, Neutrophil-to-lymphocyte ratio; PEF, Peak expiratory flow percentage; PaO_2, Partial arterial oxygen pressure; PaCO_2, Partial arterial pressure of carbon dioxide; SaO_2, Oxygen saturation; Sp-IgE, Aspergillus fumigatus specific IgE.

Table 4 The Detailed Condition of the Death Group

Died Patients	Age (Years)	Gender	Predisposing Conditions	Comorbidity	Cause of Death
Case 1	64	Male	COPD Asthma	Coronary heart disease	Pneumomediastinum AECOPD Respiratory failure
Case 2	82	Male	COPD	Coronary heart disease	AECOPD NSTEMI Respiratory failure
Case 3	83	Male	COPD	Chronic pulmonary heart disease	AECOPD Respiratory failure
Case 4	74	Male	Asthma	Coronary heart disease Acute cerebral infarction	Coronary heart disease Acute cerebral infarction
Case 5	62	Male	COPD Asthma	Pulmonary tuberculosis	Pulmonary tuberculosis AECOPD Respiratory failure
Case 6	82	Male	COPD	Chronic pulmonary heart disease	AECOPD Respiratory failure
Case 7	81	Male	Asthma	Advanced colorectal cancer	Advanced colorectal cancer
Case 8	52	Female	Asthma	Depression	Unknown
Case 9	77	Male	COPD Asthma	NSCLC	NSCLC AECOPD Respiratory failure
Case 10	69	Female	Asthma	Advanced colorectal cancer	Advanced colorectal cancer
Case 11	76	Male	COPD	Chronic pulmonary heart disease	AECOPD Heart failure Respiratory failure

Abbreviations: AECOPD, Acute exacerbations of chronic obstructive pulmonary disease; NSTEMI, Non-ST Segment Elevation Myocardial Infarction; NSCLC, Non-small-cell lung cancer.

Table 5 Comparison of Characteristics Between Patients Who Had ABPA with or Without Central Bronchiectasis

	Central Bronchiectasis		P value
	Yes (n=16)	No (n=45)
Age, years	50.94±19.06	58.60±17.35	0.145
Male	5(31.25%)	26(57.78%)	0.068
Smokers	1(6.25%)	20(44.44%)	0.006
Pack-years of smoking	0(0–0)	0(0–18.75)	0.025
Dead	1(6.25%)	10(22.22%)	0.294
Duration of ABPA, in months	592(105.00–631.00)	154.5(73.00–427.50)	0.018
BMI (kg/m^2)	20.75±3.29	23.38±3.27	0.009
Peripheral blood cells
Leukocyte, ×10^9/L	9.50±3.32	8.78±3.95	0.522
Neutrophil, ×10^9/L	5.46±2.84	5.57±3.21	0.899
Neutrophil, %	54.82±18.72	58.58±18.09	0.498
Eosinophil, ×10^9/L	0.77(0.23–0.94)	0.48(0.05–0.71)	0.029
Eosinophil, %	9.6(2.61–11.15)	6.4(0.45–13.97)	0.144
Inflammatory indicator
NLR	1.90(1.21–3.99)	4.14(1.5–7.71)	0.375
CRP, mg/L	3.94(2.25–11.70)	8.09(1.23–41.37)	0.910
ESR, mm/h	26.00(17.00–29.00)	12.00(5.25–28.75)	0.160
Immunological tests
Total IgE, IU/mL	2248.00(1011.00–2500.00)	2322.00(1262.75–2500.00)	0.398
Sp-IgE, kUA/L	13.30(3.50–25.9)	0.93(0.54–6.10)	0.001
Comorbidity
Asthma	15(93.75%)	37(82.22%)	0.480
COPD	1(6.25%)	9(20.00%)	0.377
Allergic rhinitis	8(50.00%)	24(53.33%)	0.819
Spirometry
FEV1/FVC	54.44±18.95	62.64±14.77	0.112
FEV1/pred	50.78±29.71	62.97±24.54	0.153
PEF, L/s	3.16(2.82–6.52)	3.90(3.16–5.75)	0.078
PEF, %	49.50(38.20–94.2)	65.25(43.33–87.08)	0.160
DLCO, %	66.68±31.97	74.10±18.19	0.317
DLCO/VA, mmol/min/kPa/L	1.48(1.17–1.60)	1.24(1.04–1.55)	0.616
Arterial blood gas
PaO2, mmHg	75.21±13.57	75.78±12.21	0.889
PaCO2, mmHg	41.00(40.00–52.00)	41(38.00–43.00)	0.101
SaO2, %	95.00(94.00–97.00)	96.00(94.00–97.00)	0.866
Treatment
Glucocorticoids	15(93.75%)	39(86.67%)	0.759
Antifungal Drugs	13(81.25%)	28(62.22%)	0.164

Abbreviations: BMI, Body mass index; CRP, C-reactive protein; DLCO, Diffusion capacity of carbon monoxide; VA, Alveolar volume; ESR, Erythrocyte sedimentation rate; FEV₁/FVC, Forced expiratory volume in one second (FEV₁)/forced vital capacity (FVC); FEV₁/pred, Percentage of FEV₁ predicted; IgE, Immunoglobulin E; NLR, Neutrophil-to-lymphocyte ratio; PEF, Peak expiratory flow percentage; PaO_2, Partial arterial oxygen pressure; PaCO₂, Partial arterial pressure of carbon dioxide; SaO_2, Oxygen saturation; Sp-IgE, Aspergillus fumigatus specific IgE.

Figure 3 HRCT scans of patients with ABPA.