Abstract The incidence of invasive pulmonary aspergillosis (IPA) in nonneutropenic patients is increasing. This study aimed to evaluate the clinical outcomes and risk factors for mortality in nonneutropenic IPA patients. We conducted a prospective, multicenter study from August 2020 to February 2024, enrolling 565 patients with suspected IPA. The study cohort comprised 195 IPA (nonneutropenic) cases and 370 non-IPA cases. Peripheral blood and bronchoalveolar lavage fluid (BALF) specimens were collected to measure pentraxin-3 (PTX3) levels. Additionally, demographic data, clinical characteristics, and antifungal therapy of each patient were recorded. We analyzed factors associated with 30-day and 90-day mortality. IPA patients exhibited higher mortality rates compared to non-IPA patients, with 30-day rates of 26.15% versus 8.38% (P 0.001) and 90-day rates of 34.36% versus 13.24% (P 0.001). Higher plasma and BALF PTX3 levels were associated with poor prognosis in IPA patients. ROC curve analysis identified optimal PTX3 thresholds of 4.29 ng/ml in BALF (sensitivity 67.1%, specificity 81.4%) and 7.11 ng/ml in plasma (sensitivity 73.4%, specificity 82.8%) for predicting mortality. Multivariate Cox regression analysis confirmed PTX3 levels in plasma (HR 3.87, 95%CI 1.87 - 8.00, P0.001) and BALF (HR 2.40 1.19 - 4.84, P = 0.014) were independent prognostic factors for IPA mortality. Additionally, positive galactomannan test results in both BALF and plasma were initially correlated with increased mortality in IPA patients. However, after adjusting for potential confounding factors, this correlation no longer remain statistical significance. In conclusion, PTX3 was a promising prognostic biomarker of mortality in IPA patients. This abstract is funded by: This work was supported by the Project of Natural Science Foundation of China (82270019, 82070011), and General Program of Clinical Research, Nanjing Drum Tower Hospital (2023-LCYJ-MS-18).
Su et al. (Fri,) studied this question.