Abstract / Summary
The aim of this study was to classify patients with invasive pulmonary aspergillosis (IPA), evaluate clinical and radiological characteristics and treatment, present local epidemiological data, assess EORTC/MSG performance in a heterogeneous patient group, and analyze mortality predictors. This retrospective cohort study included 160 patients whose findings could not be explained by an etiology other than IPA, between January 2018 and June 2020. Patients were classified as possible, probable, or proven IPA per EORTC/MSG criteria; those not meeting criteria were accepted as unclassified. Recorded data were compared across these categories, plus mycological, clinical (radiological) evidence, and mortality status. Of 160 patients, 97 (60.6%) were male; mean age was 51.39 ± 14.27 years. According to EORTC/MSG criteria, 1 (0.6%) had proven, 51 (31.9%) probable, 87 (54.4%) possible, and 21 (13.1%) unclassified IPA. Of 120 (75%) patients with a hematologic diagnosis, 38 (23.8%) had allogeneic and 25 (15.6%) autologous stem cell transplants. Graft-versus-host disease was more frequent in the proven/probable group ( p = 0.042). CT findings consistent with EORTC/MSG clinical (radiological) criteria were present in 144 (90%) patients. Cavity formation was more frequent with mycological evidence ( p = 0.037) and prolonged corticosteroid use with non-criteria CT pattern involvement ( p = 0.048). Voriconazole was more often first-line therapy with clinical evidence ( p = 0.034). Six-week and 12-week all-cause mortality rates were 21.2% and 31.9%, respectively. Overall, 107 (66.9%) patients died; median survival was 240 days (95% CI: 142–480). Age was higher in fatal cases ( p = 0.029), as was pleural effusion on chest CT (OR 2.326, 95% CI: 1.156–4.681, p = 0.018; not significant at 6- or 12-week timepoints, suggesting a comorbidity-driven rather than IPA-specific prognostic signal). IPA is difficult to diagnose and treat, with a poor prognosis. The observed mortality rate (66.9%) is higher than in hematologic-malignancy cohorts (~ 25–35%) but comparable to intensive care unit and non-hematologic populations, underscoring the importance of screening, early diagnosis, and treatment. EORTC/MSG-criteria CT patterns may not be present in patients on prolonged corticosteroid therapy, and mortality may be higher with pleural effusion. Non-invasive diagnostic methods are needed given the difficulty of invasive procedures. Cases not meeting EORTC/MSG criteria but clinically suspected of IPA indicate these criteria should be reviewed to avoid delaying clinical decision-making, particularly in non-classical risk groups. Not applicable.