Work

Phase characteristics and risk factors of acute-on-chronic liver failure with invasive pulmonary aspergillosis

Year: 2025

Type: article

Abstract: INTRODUCTION: The incidence of Invasive pulmonary aspergillosis (IPA) in acute-on-chronic liver failure (ACLF) population is increasing, and its diagnosis and treatment is still a major clinical conundrum. This study aimed to characterize disease-stage-specific patterns and identify independent risk factors for IPA development in ACLF. METHODS: A cohort of 835 ACLF patients (Jan 2014-Aug 2023) was retrospectively analyzed. IPA diagnosis followed Invasive Fungal Infections Group of the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG). Comparative analysis included 55 ACLF-IPA cases versus 163 pulmonary infection controls without IPA. Multivariate logistic regression established risk factors, with predictive performance evaluated by ROC analysis. RESULTS: The rate of clinical diagnosis of IPA in 835 ACLF patients was 6.6% (55/835). The median interval from ACLF diagnosis to IPA diagnosis was 31 days. The logistic regression model was C-Aged = 1.531 × [cirrhosis (yes:1, no:0)] + 1.511 × [diabetes mellitus (yes:1, no:0)] + 0.811 × [steroid exposure (yes:1, no:0)] + 0.033 × age + 1.520 × [types of broad-spectrum antibiotics ≥ 3 (yes:1, no:0)] -6.155. The derived predictive model demonstrated strong discrimination (AUROC = 0.828). CONCLUSIONS: IPA predominantly manifests in advanced ACLF stages (≥ 28 days). Critical risk factors include cirrhosis, diabetes, glucocorticoid use, advanced age, and multi-class antibiotic exposure. These findings enable risk-stratified surveillance and early intervention.

Source: BMC Infectious Diseases

DOI: 10.1186/s12879-025-11518-w