{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:38:09Z","timestamp":1782970689005,"version":"3.54.5"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to develop and assess a meta-analysis-informed diagnostic stratification tool for invasive pulmonary aspergillosis (IPA) in patients with severe fever with thrombocytopenia syndrome (SFTS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis were conducted to identify bedside clinical factors associated with IPA\/SFTS-associated pulmonary aspergillosis (SAPA) in patients with SFTS. Because individual participant data were unavailable, pooled study-level odds ratios were translated into a pragmatic three-variable diagnostic stratification score rather than a conventional individual-level prediction model. The tool was assessed in a separate single-center retrospective cohort of 220 patients with SFTS, among whom 63 (28.6%) met the clinically ascertained IPA\/SAPA endpoint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six studies involving 2,342 patients with SFTS, including 407 patients with IPA\/SAPA, were included in the quantitative meta-analysis. In the primary random-effects analyses, neurological symptoms showed the clearest pooled association with increased IPA\/SAPA risk, whereas ICU admission and corticosteroid use showed positive but less precise pooled directions of effect. The final three-variable score assigned 9 points for neurological symptoms, 9 points for ICU admission, and 6 points for corticosteroid use, yielding a total score range of 0\u201324 points. In the single-center cohort-based assessment, the diagnostic stratification tool showed encouraging discrimination, with an AUC of 0.910 (95% CI, 0.869\u20130.951) and a Brier score of 0.097 after cohort-based logistic recalibration. The observed IPA\/SAPA incidence increased stepwise across low-, medium-, and high-risk groups: 3.7% (4\/108), 22.8% (13\/57), and 83.6% (46\/55), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This meta-analysis-informed diagnostic stratification tool showed encouraging cohort-based risk separation in a single-center retrospective assessment. It may help prioritize fungal diagnostic work-up and surveillance intensity in patients with SFTS and support more targeted diagnostic resource allocation and antifungal stewardship. However, it should not be used as a stand-alone basis for antifungal treatment decisions or as a broadly generalizable individual-level prediction model. External validation, local recalibration, and prospective multicenter evaluation are required before clinical implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?RecordID=5115813<\/jats:ext-link>\n                      , identifier CRD420251115813.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1747950","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:25:33Z","timestamp":1782966333000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A meta-analysis-informed diagnostic stratification tool for invasive pulmonary aspergillosis in severe fever with thrombocytopenia syndrome: systematic review, meta-analysis, and single-center cohort-based assessment"],"prefix":"10.3389","volume":"16","author":[{"given":"Ruize","family":"Ma","sequence":"first","affiliation":[{"name":"National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuwen","family":"Ding","sequence":"additional","affiliation":[{"name":"National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanli","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Yantai Qishan Hospital for Infectious Disease","place":["Yantai, 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