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Early Detection of Aspergillus Species in Lower Respiratory Tract is Associated with Higher Mortality in Viral Community-Acquired Pneumonia: A Multicenter Prospective Cohort Study in China

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Abstract

Purpose

Community-acquired pneumonia (CAP) is a leading cause of adult mortality worldwide and poses a significant global burden. Previous studies have indicated a tendency for viral pneumonia, particularly severe influenza virus pneumonia, to be complicated by Aspergillus superinfection. However, the clinical features and prognostic implications of Aspergillus detection in early-onset viral CAP remain unclear.

Methods

We conducted a prospective multicenter observational cohort study in China involving CAP patients. Adult patients with CAP from six hospitals were enrolled between January 2017 and October 2018. Within 72 h of admission, lower respiratory tract specimens, including sputum and alveolar lavage fluid, were collected. Comprehensive pathogenic testing, utilizing molecular biology techniques, was performed on the collected specimens, encompassing bacteria, atypical pathogens, viruses, and fungi. Patient clinical data were collected through a unified electronic medical record website system.

Results

A total of 382 adult CAP patients were included in the study. The viral detection rate was 38% (145/382), with Aspergillus identified in 11.0% (16/145) of viral CAP cases. Mortality among Aspergillus-positive patients was significantly higher (25%, 4/16) compared to Aspergillus-negative patients (5.4%, 7/129) in viral CAP (P = 0.021). Multivariable logistic regression models demonstrated that the presence of Aspergillus at admission might increase the mortality risk in viral CAP [OR (95%CI) = 7.34 (0.92–58.65), P = 0.06]. Furthermore, Aspergillus-positive patients exhibited a significantly lower lymphocyte count than Aspergillus-negative patients (P = 0.047).

Conclusion

Positive detection of Aspergillus in lower respiratory tract specimens might be associated with higher mortality in early-onset viral CAP.

Trial Registration

ClinicalTrials.gov, NCT03093220. Registered retrospectively on 28 March 2017.

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Acknowledgements

The authors wish to thank staff members of the cooperating hospitals (Fujian Provincial Hospital, Fuzhou, China; West China Hospital, Chengdu, China; Second Hospital of Jilin University, Changchun, China; Shanghai Pulmonary Hospital, Shanghai, China; Tibet Autonomous Region People’s Hospital, Lasa, China) for assistance with samples and clinical data collection.

Funding

The work was funded by grants from the National Key Research and Development Program “Precision Medicine Research” from the Ministry of Science and Technology of China (2016YFC0903800), National Natural Science Foundation of China (8200011769) and Peking University People’s Hospital Research and Development Funds (RDJP2022-43).

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Author notes

  1. Lu Yin and Ying Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China

    Lu Yin, Ying Zhang, Lili Zhao, Wentao Ni & Zhancheng Gao

  2. Department of Respiratory and Critical Care and Sleep Medicine, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361101, China

    Yali Zheng

  3. Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China

    Qiongzhen Luo

  4. Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China

    Yu Xu

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  1. Lu Yin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Lu Yin, Ying Zhang, Wentao Ni, Yali Zheng and Qiongzhen Luo. The project management was performed by Lili Zhao. The first draft of the manuscript was written by Lu Yin, Ying Zhang and Wentao Ni, and all authors commented on previous versions of the manuscript. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Wentao Ni, Yu Xu or Zhancheng Gao.

Ethics declarations

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board of the Peking University People’s Hospital (No. 2011-83).

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Informed Consent was obtained from all individual participants included in the study.

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The authors have no relevant financial or non-financial interests to disclose.

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Yin, L., Zhang, Y., Zheng, Y. et al. Early Detection of Aspergillus Species in Lower Respiratory Tract is Associated with Higher Mortality in Viral Community-Acquired Pneumonia: A Multicenter Prospective Cohort Study in China. Lung 201, 387–396 (2023). https://doi.org/10.1007/s00408-023-00638-2

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