A multidimensional grading system for ABPA treatment escalation within the first year: The HEID score

Zhang Ping'an, MD; Ma Yanliang, MD; Chen Xi, MD; Ma Yifan, MD; Yang Luyang, MM; Zhang Moqin, MD; Gao Zhancheng, PhD

World Allergy Organization Journal (Dec 2024)

A multidimensional grading system for ABPA treatment escalation within the first year: The HEID score

Zhang Ping'an, MD,
Ma Yanliang, MD,
Chen Xi, MD,
Ma Yifan, MD,
Yang Luyang, MM,
Zhang Moqin, MD,
Gao Zhancheng, PhD

Affiliations

Zhang Ping'an, MD: Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Peking University, Beijing, China
Ma Yanliang, MD: Corresponding author. Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, No.11 Xizhimen South Street, Xi Cheng District, Beijing 100044, China.; Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Peking University, Beijing, China
Chen Xi, MD: Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Peking University, Beijing, China
Ma Yifan, MD: Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Peking University, Beijing, China
Yang Luyang, MM: Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Peking University, Beijing, China
Zhang Moqin, MD: Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Peking University, Beijing, China
Gao Zhancheng, PhD: Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Peking University, Beijing, China

Journal volume & issue: Vol. 17, no. 12
p. 100996

Abstract

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Background: Susceptibility to relapse is an important feature of allergic bronchopulmonary aspergillosis (ABPA); early identification of patients at high risk of relapse is urgently needed. A practical score that classifies the severity of ABPA according to its prognosis is not available. Methods: We retrospectively reviewed patients with a diagnosis of ABPA at our hospital between January 2010 and December 2022. Logistic regression analysis was used to investigate independent risk factors for ABPA treatment escalation and select the variables included in the final score. Results: One hundred and three patients with ABPA were enrolled in this study. An eosinophil count >1000/μL, Aspergillus fumigatus–specific IgE (Sp-IgE) >3.5 kUA/L, expectoration of brownish-black mucus plugs, high-attenuation mucus (HAM) and a percentage of the predicted diffusing capacity of carbon monoxide (DLCO/pred) < 60% were independent risk factors for ABPA treatment escalation. Initial treatment with antifungals was an independent protective factor. The final scale, designated HEID, incorporated 4 dichotomized variables: HAM (H, 1 point); eosinophil count (E, cutoff 1000/μL, 1 point); Sp-IgE (I, cutoff 3.5 kUA/L, 1 point) and DLCO/pred (D, cutoff 60%, 1 point). A score of 0–1 point indicated a low relapse risk; 2–4 points indicated a high relapse risk. Conclusion: This easy-to-use multidimensional grading system was capable of accurately classifying the risk of treatment escalation in ABPA.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

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