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Outcomes with severe blastomycosis and respiratory failure in the United States.

BACKGROUND: The outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) is not well understood in the modern era. Limited historical case series have reported 50-90% mortality in patients with Acute Respiratory Distress Syndrome (ARDS) caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis.

METHODS: We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2006-2014. Patients >18 years of age with a diagnosis of blastomycosis who received mechanical ventilation were included.

RESULTS: There were 1,848 patients with a diagnosis of blastomycosis included in the study. Of this cohort, 219 (11.9%) patients underwent MV with a mortality rate of 39.7% compared to 2.5% in patients not requiring ventilatory support (p<0.01). The median time to death for patients requiring MV was 12 days (IQR 8-16). The median length of hospital stay for survivors of MV was 22 days (IQR 14-37). The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, p=0.05) and was lower for those receiving care at a rural hospital (12.3% vs 17.2%, p=0.04). In a multivariate model, female gender was associated with increased risk of mortality (OR 1.84, 95% CI 1.06-3.20, p=0.03) as was increasing patient age (10-year age increase OR 1.64, 95% CI 1.33-2.02, p<0.01).

CONCLUSIONS: In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at approximately 40%; 16-fold higher than those without MV.

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