Immunocompromise and early-onset invasive pulmonary aspergillosis in viral pneumonia: a retrospective cohort study

TL;DR

Immunocompromised patients with viral pneumonia are more likely to develop early-onset invasive pulmonary aspergillosis and face worse outcomes.

Contribution

This study identifies immunocompromised status as an independent risk factor for early-onset invasive pulmonary aspergillosis in viral pneumonia.

Findings

Immunocompromised patients had significantly higher rates of invasive mechanical ventilation, IPA incidence, and 30-day mortality.

Immunocompromised status was an independent risk factor for IPA development (adjusted HR, 2.33).

Immunocompromised hosts accounted for 80% of early-onset IPA cases and were a strong predictor of early diagnosis (adjusted OR 35.7).

Abstract

In the context of viral pneumonia, immunocompromised status represents a recognized risk factor for invasive pulmonary aspergillosis (IPA), its association with the timing of IPA diagnosis remains unclear.

In the present study, 261 patients hospitalized with viral pneumonia were consecutively enrolled and categorized as immunocompromised hosts (ICHs) or non-ICHs. Baseline characteristics, outcomes, and time to IPA diagnosis were compared. Cox regression was used to evaluate the association between immunocompromised status and adverse outcomes. Patients diagnosed with IPA were further stratified into early (diagnosis within 5 days of admission) and late groups. Logistic regression was employed to evaluate the association of immunocompromised status with early-onset IPA.

Among the enrolled patients, 122 (46.7%) were immunocompromised. Relative to the non-ICH group, ICH patients were older, had a lower body mass index, and contained a smaller proportion of never-smokers. They also presented with higher respiratory rates, CRP, PCT, lower PaO₂/FiO₂ ratios, and greater illness severity. Significantly higher rates of invasive mechanical ventilation (20.5% vs. 2.2%), IPA incidence (22.1% vs. 9.4%), and 30-day mortality (23.8% vs. 5.0%) were observed in the ICH group compared to the non-ICH group. Multivariable Cox regression identified immunocompromised status as an independent risk factor for IPA (adjusted HR, 2.33; 95% CI, 1.07–5.06). Strikingly, immunocompromised hosts (ICHs) accounted for 80.0% of the early-onset IPA cases, compared to only 46.2% in the late-onset group. This association was confirmed in the adjusted analysis, where immunocompromised status remained a powerful independent risk factor for early diagnosis (adjusted OR 35.7, 95% CI 3.71–763.00).

Immunocompromised status is an independent risk factor for both the development and earlier onset of IPA in patients with viral pneumonia, underscoring the need for heightened vigilance and early investigation in this high-risk population.

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