{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T21:43:24Z","timestamp":1781732604447,"version":"3.54.5"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In the context of viral pneumonia, immunocompromised status represents a recognized risk factor for invasive pulmonary aspergillosis (IPA), its association with the timing of IPA diagnosis remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In the present study, 261 patients hospitalized with viral pneumonia were consecutively enrolled and categorized as immunocompromised hosts (ICHs) or non-ICHs. Baseline characteristics, outcomes, and time to IPA diagnosis were compared. Cox regression was used to evaluate the association between immunocompromised status and adverse outcomes. Patients diagnosed with IPA were further stratified into early (diagnosis within 5\u202fdays of admission) and late groups. Logistic regression was employed to evaluate the association of immunocompromised status with early-onset IPA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the enrolled patients, 122 (46.7%) were immunocompromised. Relative to the non-ICH group, ICH patients were older, had a lower body mass index, and contained a smaller proportion of never-smokers. They also presented with higher respiratory rates, CRP, PCT, lower PaO\u2082\/FiO\u2082 ratios, and greater illness severity. Significantly higher rates of invasive mechanical ventilation (20.5% vs. 2.2%), IPA incidence (22.1% vs. 9.4%), and 30-day mortality (23.8% vs. 5.0%) were observed in the ICH group compared to the non-ICH group. Multivariable Cox regression identified immunocompromised status as an independent risk factor for IPA (adjusted HR, 2.33; 95% CI, 1.07\u20135.06). Strikingly, immunocompromised hosts (ICHs) accounted for 80.0% of the early-onset IPA cases, compared to only 46.2% in the late-onset group. This association was confirmed in the adjusted analysis, where immunocompromised status remained a powerful independent risk factor for early diagnosis (adjusted OR 35.7, 95% CI 3.71\u2013763.00).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Immunocompromised status is an independent risk factor for both the development and earlier onset of IPA in patients with viral pneumonia, underscoring the need for heightened vigilance and early investigation in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1723842","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T06:27:44Z","timestamp":1768458464000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Immunocompromise and early-onset invasive pulmonary aspergillosis in viral pneumonia: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Borui","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Unit 1, Handan Central Hospital","place":["Handan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiechao","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Unit 1, Handan Central Hospital","place":["Handan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyi","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Unit 2, Handan Central Hospital","place":["Handan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Unit 1, Handan Central Hospital","place":["Handan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weizheng","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Unit 1, Handan Central Hospital","place":["Handan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Unit 1, Handan Central Hospital","place":["Handan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuehang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Unit 1, Handan Central Hospital","place":["Handan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1496","DOI":"10.1056\/NEJMra2027424","article-title":"Aspergillus infections","volume":"385","author":"Thompson","year":"2021","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1136\/thoraxjnl-2014-206291","article-title":"The clinical spectrum of pulmonary aspergillosis","volume":"70","author":"Kosmidis","year":"2015","journal-title":"Thorax"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1016\/S2213-2600(24)00151-6","article-title":"Influenza-associated and COVID-19-associated pulmonary aspergillosis in critically ill patients","volume":"12","author":"Feys","year":"2024","journal-title":"Lancet Respir Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.mib.2021.04.006","article-title":"Invasive pulmonary aspergillosis associated with viral pneumonitis","volume":"62","author":"Dewi","year":"2021","journal-title":"Curr Opin Microbiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1007\/s00134-012-2673-2","article-title":"Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study","volume":"38","author":"Wauters","year":"2012","journal-title":"Intensive Care Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S121","DOI":"10.1093\/cid\/ciaa1751","article-title":"EORTC\/MSGERC definitions of invasive fungal diseases: summary of activities of the intensive care unit working group","volume":"72","author":"Bassetti","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1164\/rccm.201111-1978OC","article-title":"A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients","volume":"186","author":"Blot","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s13054-014-0722-7","article-title":"Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes","volume":"19","author":"Taccone","year":"2015","journal-title":"Crit Care"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1016\/j.chest.2023.09.019","article-title":"Prevalence, risk factors, clinical features, and outcome of influenza-associated pulmonary aspergillosis in critically ill patients: a systematic review and Meta-analysis","volume":"165","author":"Lu","year":"2024","journal-title":"Chest"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/S2213-2600(23)00408-3","article-title":"Risk factors for COVID-19-associated pulmonary aspergillosis: a systematic review and meta-analysis","volume":"12","author":"Gioia","year":"2024","journal-title":"Lancet Respir Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1183\/09031936.00073807","article-title":"Virological diagnosis in community-acquired pneumonia in immunocompromised patients","volume":"31","author":"Camps Serra","year":"2008","journal-title":"Eur Respir J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/s10096-002-0864-4","article-title":"Respiratory disease due to parainfluenza virus in adult leukemia patients","volume":"22","author":"Marcolini","year":"2003","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1159\/000085367","article-title":"Respiratory syncytial virus pneumonitis in immunocompromised adults: clinical features and outcome","volume":"72","author":"Ebbert","year":"2005","journal-title":"Respiration"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1046\/j.1365-2141.2002.03515.x","article-title":"Prevention and treatment of viral infections in stem cell transplant recipients","volume":"118","author":"Ljungman","year":"2002","journal-title":"Br J Haematol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e12994","DOI":"10.1111\/tid.12994","article-title":"Risk factors for mortality after respiratory syncytial virus lower respiratory tract infection in adults with hematologic malignancies","volume":"20","author":"Vakil","year":"2018","journal-title":"Transpl Infect Dis"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1038\/sj.bmt.1704380","article-title":"Outbreaks of infectious diseases in stem cell transplant units: a silent cause of death for patients and transplant programmes","volume":"33","author":"McCann","year":"2004","journal-title":"Bone Marrow Transplant"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1186\/s13054-014-0458-4","article-title":"How to manage aspergillosis in non-neutropenic intensive care unit patients","volume":"18","author":"Bassetti","year":"2014","journal-title":"Crit Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/ciw326","article-title":"Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America","volume":"63","author":"Patterson","year":"2016","journal-title":"Clin Infect Dis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1016\/S2213-2600(18)30274-1","article-title":"Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study","volume":"6","author":"Schauwvlieghe","year":"2018","journal-title":"Lancet Respir Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1097\/CM9.0000000000002354","article-title":"Clinical features and risk factors for viral pneumonia complicated with invasive pulmonary aspergillosis in adult patients","volume":"136","author":"Li","year":"2023","journal-title":"Chin Med J"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1111\/myc.13410","article-title":"Incidence, risk factors and mortality of invasive pulmonary aspergillosis in patients with influenza: a systematic review and meta-analysis","volume":"65","author":"Shi","year":"2022","journal-title":"Mycoses"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s00134-016-4578-y","article-title":"Increased incidence of co-infection in critically ill patients with influenza","volume":"43","author":"Martin-Loeches","year":"2017","journal-title":"Intensive Care Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1016\/j.jinf.2020.07.036","article-title":"Early identification of patients with severe influenza-associated aspergillosis (IAA) in the intensive care unit--an IAA prediction score system (Asper-PreSS)","volume":"81","author":"Huang","year":"2020","journal-title":"J Infect"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"644","DOI":"10.3390\/antibiotics9100644","article-title":"Preliminary attempt to predict risk of invasive pulmonary aspergillosis in patients with influenza: decision trees may help?","volume":"9","author":"Bellelli","year":"2020","journal-title":"Antibiotics"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"S193","DOI":"10.1093\/infdis\/jiz682","article-title":"Invasive pulmonary aspergillosis in adults with avian influenza a (H7N9) pneumonia in China: a retrospective study","volume":"221","author":"Zou","year":"2020","journal-title":"J Infect Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1016\/j.cmi.2020.07.010","article-title":"Incidence of invasive pulmonary aspergillosis among critically ill COVID-19 patients","volume":"26","author":"Lamoth","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1111\/myc.13213","article-title":"Invasive pulmonary aspergillosis in the COVID-19 era: an expected new entity","volume":"64","author":"Machado","year":"2021","journal-title":"Mycoses"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e48","DOI":"10.1016\/S2213-2600(20)30237-X","article-title":"Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19","volume":"8","author":"Alanio","year":"2020","journal-title":"Lancet Respir Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e3606","DOI":"10.1093\/cid\/ciaa1065","article-title":"Epidemiology of invasive pulmonary aspergillosis among intubated patients with COVID-19: a prospective study","volume":"73","author":"Bartoletti","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e1634","DOI":"10.1093\/cid\/ciaa1298","article-title":"A National Strategy to diagnose coronavirus disease 2019-associated invasive fungal disease in the intensive care unit","volume":"73","author":"White","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"790.e1","DOI":"10.1016\/j.cmi.2020.12.005","article-title":"Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort","volume":"27","author":"Delli\u00e8re","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"220114","DOI":"10.1183\/16000617.0114-2022","article-title":"Pulmonary aspergillosis: diagnosis and treatment","volume":"31","author":"Lamoth","year":"2022","journal-title":"Eur Respir Rev"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.idc.2021.03.008","article-title":"Aspergillosis: epidemiology, diagnosis, and treatment","volume":"35","author":"Cadena","year":"2021","journal-title":"Infect Dis Clin N Am"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1007\/s00134-019-05789-6","article-title":"Invasive pulmonary aspergillosis in critically ill patients with hematological malignancies","volume":"45","author":"Pardo","year":"2019","journal-title":"Intensive Care Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"i5","DOI":"10.1093\/jac\/dkq437","article-title":"Risk assessment and prognostic factors for mould-related diseases in immunocompromised patients","author":"Pagano","year":"2011","journal-title":"J Antimicrob Chemother"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s00134-024-07767-z","article-title":"A multivariable prediction model for invasive pulmonary aspergillosis in immunocompromised patients with acute respiratory failure (IPA-GRRR-OH score)","volume":"51","author":"Friol","year":"2025","journal-title":"Intensive Care Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1055\/s-0039-3401990","article-title":"Invasive pulmonary aspergillosis","volume":"41","author":"Ledoux","year":"2020","journal-title":"Semin Respir Crit Care Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1056\/NEJMoa061094","article-title":"Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia","volume":"356","author":"Cornely","year":"2007","journal-title":"N Engl J Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1093\/cid\/ciy181","article-title":"Epidemiology and outcomes of hospitalizations with invasive aspergillosis in the United States, 2009-2013","volume":"67","author":"Zilberberg","year":"2018","journal-title":"Clin Infect Dis"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"8","DOI":"10.12688\/f1000research.17836.1","article-title":"New hematologic populations at risk of invasive aspergillosis: focus on new targeted, biological, and cellular therapies","volume":"8","author":"Girmenia","year":"2019","journal-title":"F1000Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1136\/thoraxjnl-2020-216179","article-title":"Lung microbiota predict invasive pulmonary aspergillosis and its outcome in immunocompromised patients","volume":"77","author":"H\u00e9rivaux","year":"2022","journal-title":"Thorax"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1186\/s12879-021-06437-5","article-title":"Characteristics of viral pneumonia in non-HIV immunocompromised and immunocompetent patients: a retrospective cohort study","volume":"21","author":"Li","year":"2021","journal-title":"BMC Infect Dis"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1723842\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T06:27:44Z","timestamp":1768458464000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1723842\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,15]]},"references-count":42,"alternative-id":["10.3389\/fpubh.2025.1723842"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1723842","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,15]]},"article-number":"1723842"}}