[13, 14] Similar studies in patients with haematological malignancies and HSCT[15-18] or solid organ transplantation[19, 20] with invasive aspergillosis have demonstrated several prognostic risk factors of mortality, which may assist in the development of treatment intensity algorithms and clinical trials. In our univariate analysis, 12 such variables were found to be significantly different between 4-week survivors and non-survivors; male sex, total bilirubin, thrombocytopenia, LDH, creatinine clearance, acidosis, GvHD, active malignancy,

severe neutropenia, lymphocytopenia, monocytopenia and voriconazole breakthrough infection. Nevertheless, multivariate analysis accounting for severity of underlying disease revealed only baseline severe lymphocytopenia and a high LDH serum level (>655 mg dl−1) buy Lumacaftor as independent predictors of early death. check details Consequently, we identified two different prognostic groups using these variables: patients with a 28-day crude mortality rate of <15% (score ≤22) and

patients with a mortality rate of 75% (score >22). The outcome of mucormycosis depends on several factors, including the site of infection, the immune status of the host and the use of surgery or other adjunctive treatments.[21, 22] Chamilos et al. [7] reported that the initiation of polyene therapy within 5 days after diagnosis of mucormycosis was associated with improvement in survival, compared with initiation of polyene therapy at ≥6 days after diagnosis (83% vs. 49% survival). In the same study,

active malignancy (P = 0.003) and monocytopenia (P = 0.01) at the time of diagnosis of infection were also independently associated with a poor outcome, whereas salvage posaconazole-based therapy (P = 0.01) and neutrophil recovery (P = 0.009) were predictive of a favourable outcome.[7] However, this analysis included patients prior to 2000 when diagnosis and treatment outcomes were considerably worse than the PAK6 current era. Likewise, previous investigators have emphasised the important role of early neutrophil recovery and treatment with high-dose amphotericin B.[23-25] Of interest, a recent prospective study on 20 patients with mucormycosis (with pulmonary and non-pulmonary sites of infection) showed that active malignancy (P = 0.03), neutropenia (P = 0.03) and iron overload (P = 0.03) were significantly associated with 90-day mortality in univariate analysis, whereas no association was found with amphotericin B dose or the use of other antifungal therapy (i.e. echinocandin and posaconazole).[8] Nevertheless, in the current study, only lymphocytopenia and high LDH levels, which probably reflects activity of the underlying malignant disease, were significant risk factors for poor outcome when analysis was adjusted for underlying severity of illness (APACHE II).