Chest CT findings and biomarker predictors of mortality in pediatric invasive pulmonary aspergillosis: a retrospective cohort study

Invasive pulmonary aspergillosis (IPA) remains a life-threatening infection in children with cancer. We evaluated chest CT findings and the prognostic significance of serum galactomannan (GM) and inflammatory biomarkers in pediatric IPA. In this single-center retrospective cohort study, immunocompromised children (< 18 years) screened for IPA at Amir Oncology Teaching Hospital (Shiraz, Iran) between April 2016 and December 2023 were evaluated. The primary analytical cohort included patients with proven/probable IPA, while possible IPA cases were analyzed descriptively. Available chest CT scans were reviewed using predefined criteria. All-cause mortality was analyzed using Kaplan–Meier estimates and multivariable Cox models; secondary analyses assessed predictors of nodules and nodule burden. The study investigated 141 patients with proven/probable IPA (median age 8 years; 63.1% male; 14.2% proven). Pulmonary nodules were the most frequent CT finding (75/141), followed by consolidation (44/141) and halo sign (37/141); ground-glass opacities and pleural effusion each occurred in 16/141. Nodules most commonly co-occurred with halo sign (33 cases). Among the 136 patients included in survival analysis, 41 deaths occurred during follow-up. Estimated survival was 96% at 4 weeks and 66.3% at the end of follow-up. In multivariable Cox proportional hazards models, higher CRP (HR 1.02, 95% CI: 1.01–1.03; p < 0.001) and serum GM (HR 1.06, 95% CI: 1.02–1.10; p < 0.001) independently predicted mortality, whereas CT nodule presence, burden, and size were not significantly associated with survival. Chest CT primarily supported disease detection and radiologic characterization, whereas serum GM and CRP demonstrated greater prognostic value for mortality risk stratification within diagnosed IPA. Not applicable.