Ming Xue, Zijing Zhou, Yali Chao, Jiaqiong Li, Jun Wang, Zhuxi Yu, Xiangrong Zuo, Shujun Zhou, Yanli Wang, Xuehua Pu, Chenliang Sun, Jiangquan Yu, Songqiao Liu, Jianfeng Xie, Ruiqiang Zheng, Yi Yang
In the post-COVID-19 era, IPA is highly prevalent and lethal in severe influenza, with rapid onset. Protocolized screening and timely diagnostic strategies are urgently needed.
BACKGROUND: To determine the incidence, risk factors, and outcomes of invasive pulmonary aspergillosis (IPA) in critically ill patients with Influenza A pneumonia in post-COVID-19 China.
METHODS: We conducted a multicenter retrospective cohort study across 21 ICUs (November 2024-February 2025) including adults with acute respiratory failure due to confirmed severe Influenza A pneumonia. IPA was defined by 2024 FUNDICU criteria. The primary outcome was 60-day all-cause mortality.
RESULTS: Among 542 patients, 179 (33.0%) had IPA. Independent risk factors: renal replacement therapy (aOR 1.63), diabetes (aOR 1.79), bacterial co-infection (aOR 1.64), pre-ICU systemic glucocorticoids (aOR 2.13), and ICU steroids (aOR 1.53). Median time from influenza to IPA diagnosis was 2 days. Sixty-day mortality was higher with IPA (47.5% vs 32.0%, P<0.001), persisting after matching. Among IPA patients, hematologic disorders (aHR 5.31) and higher CRP predicted death.
CONCLUSIONS: In the post-COVID-19 era, IPA is highly prevalent and lethal in severe influenza, with rapid onset. Protocolized screening and timely diagnostic strategies are urgently needed.