Clinical Features and Predictive Risk Factors for Prognosis in Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis

BACKGROUND: Invasive pulmonary aspergillosis (IPA) and pulmonary mucormycosis (PM) stand as the most prevalent invasive mold pulmonary infections. The incidence of IPA and PM has progressively increased. Untimely or inappropriate intervention amplifies mortality rates in patients affected by IPA and PM. There exist numerous commonalities between the two with regard to the population susceptible to the disease and imaging characteristics. This renders it challenging to differentiate them in certain clinical practices, resulting in issues such as the inappropriate selection of treatment plans. Early and expeditious differential diagnosis of invasive pulmonary mold infections and prompt identification of severe cases are critical challenges in clinical practice. METHODS: A retrospective cohort study encompassed IPA and PM patients admitted to Beijing Chao-Yang Hospital from 2017 to 2022. Patients in the cohort were categorized into PM and IPA groups. A comprehensive analysis of clinical characteristics, laboratory parameters, and chest radiology findings was conducted. Subsequently, a comparative assessment of the prognosis between the two patient groups was carried out. All patients with invasive pulmonary mold infection were classified based on prognosis, and independent risk factors for poor prognosis were identified. Subsequent to these findings, exploration of novel disease assessment tools was undertaken, and their diagnostic efficacy was evaluated. RESULTS: In comparison to IPA, PM patients exhibited a younger age profile, with a higher incidence of diabetes and solid organ transplantation. PM occurrences postinfluenza infection were less frequent than IPA. Radiologically, consolidation and bronchial lumen stenosis were more prevalent in PM patients. Additionally, the diagnosis of PM patients relied more on pathological confirmation. No significant disparities were noted regarding ICU stays, mechanical ventilation ratios, and 90-day mortality between PM and IPA. Postinfluenza infection and the neutrophil-to-lymphocyte ratio (NLR) were identified as independent risk factors for ICU stays in PM/IPA patients. Postinfluenza infection and elevated hemoglobin A1c (HbA1c) levels were independent risk factors for mechanical ventilation. NLR, HbA1c levels, and postinfluenza infection collectively enhanced the predictive capacity of existing assessment tools for adverse outcomes in PM/IPA patients. CONCLUSIONS: PM patients exhibit distinctions from IPA in certain clinical characteristics, laboratory parameters, and chest radiology findings. Nevertheless, both PM and IPA patients experienced higher 90-day mortality and ICU utilization. The combination of NLR and HbA1c with existing disease assessment tools proves effective in prognosticating the disease, particularly during influenza epidemic seasons.