# Serum Aspergillus Immunoglobulin G as an Independent Biomarker for Extrasinonasal Involvement in Chronic Invasive Aspergillus Rhinosinusitis

## TL;DR

This study shows that Aspergillus IgG antibodies in the blood can predict if a fungal sinus infection has spread beyond the sinuses and how well patients respond to treatment.

## Contribution

The study identifies serum Aspergillus IgG as a novel noninvasive biomarker for predicting extrasinonasal involvement and monitoring treatment in chronic invasive fungal rhinosinusitis.

## Key findings

- Seropositivity for Aspergillus IgG was significantly higher in patients with extrasinonasal involvement (59.2%) compared to those without (8.9%).
- Aspergillus IgG antibodies were an independent predictor of extrasinonasal involvement with an odds ratio of 11.28.
- Antibody levels decreased significantly in patients achieving radiological and clinical remission after antifungal therapy.

## Abstract

To investigate the seroprevalence of Aspergillus IgG antibodies among patients with chronic invasive Aspergillus rhinosinusitis (CIARS) and to assess their prognostic value for extrasinonasal involvement and therapeutic outcomes.

A total of 132 patients with histopathologically confirmed CIARS were included. Serum Aspergillus IgG antibody levels were measured by enzyme-linked immunosorbent assay. Univariate and multivariable analyses were conducted to identify independent predictors of extrasinonasal involvement. To evaluate the prognostic value of antibody monitoring, serial Aspergillus IgG levels were assessed, and their association with radiological remission was analyzed.

Among the 132 patients, 50 (37.9%) tested positive for Aspergillus IgG antibodies. Seropositivity was significantly higher among patients with extrasinonasal involvement than among those without such involvement (59.2% vs 8.9%; P < .001). Multivariable analysis identified positive serum Aspergillus IgG antibodies (odds ratio [OR] = 11.28, 95% confidence interval [CI]: 3.67–34.64, P < .001), sphenoid sinus involvement (OR = 4.72, 95% CI: 1.89–11.79, P < .001), and ethmoid sinus involvement (OR = 5.22, 95% CI: 1.53–17.86, P = .008) as independent predictors of extrasinonasal involvement. Serial antibody monitoring was conducted to evaluate treatment outcomes, revealed a significant decrease in Aspergillus IgG levels in the radiological and clinical remission groups after antifungal therapy (median = 16.12 NovaTec units [NTU]; interquartile range [IQR] = 12.87–21.96 vs median = 9.21 NTU; IQR = 6.52–13.23; P < .001). In contrast, no significant change was observed in the stable disease group.

Aspergillus IgG antibody is a promising noninvasive biomarker associated with extrasinonasal invasion and disease progression in CIARS.

Aspergillus immunoglobulin G antibodies, a noninvasive serological biomarker, might predict extrasinonasal involvement and monitor therapeutic response in chronic invasive fungal rhinosinusitis, thereby providing valuable prognostic insight and supporting timely antifungal therapy.

Graphical AbstractThis graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/aspergillus-igg-an-independent-biomarker-for-extrasinonasal-and-disease-progression-in-chronic-invasive-aspergillus-rhinosinusitis?utm_campaign=tidbitlinkshare&utm_source=IOFor image description, please refer to the figure legend and surrounding text.

This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/aspergillus-igg-an-independent-biomarker-for-extrasinonasal-and-disease-progression-in-chronic-invasive-aspergillus-rhinosinusitis?utm_campaign=tidbitlinkshare&utm_source=IO