Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Hatzl, S; Geiger, C; Kriegl, L; Scholz, L; Reisinger, AC; Kreuzer, P; Fruhwald, S; Wölfler, A; Reinisch, A; von, Lewinski, D; Schilcher, G; Hoenigl, M; Eller, P; Krause, R.
Performance of Diagnostic Algorithms in Patients With Invasive Pulmonary Aspergillosis.
Clin Infect Dis. 2025; 80(5):1080-1087
Doi: 10.1093/cid/ciae633
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- Führende Autor*innen der Med Uni Graz
- Hatzl Stefan
- Krause Robert
- Co-Autor*innen der Med Uni Graz
- Eller Philipp
- Fruhwald Sonja
- Hönigl Martin
- Kreuzer Philipp
- Kriegl Lisa
- Reinisch Andreas
- Reisinger Alexander Christian
- Schilcher Gernot
- Scholz Laura
- von Lewinski Dirk
- Wölfler Albert
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- Abstract:
- BACKGROUND: Invasive pulmonary aspergillosis (IPA), once limited to immunocompromised patients, is now a severe complication in critically ill ICU patients without classic risk factors. Due to the difficulty of obtaining histological evidence, diagnosis relies on poorly tested algorithms in real-world settings. METHODS: We conducted a retrospective multicenter (n = 9) cohort study including 202 patients with IPA. Patients were classified using a multistep process based on the EuropeanOrganization- for-the-Research-and-Treatment-of-Cancer/Mycosis-Study Group (EORTC-MSG), Invasive-Fungal-Diseases-in-Adult-Patients-in-Intensive-Care-Unit (FUNDICU), Aspergillus-ICU (Asp-ICU), and Asp-ICU with biomarkers (Asp-ICU-BM) criteria. We then evaluated the predictive performance of these criteria against the clinical cohort and histologically proven cases. RESULTS: Among 202 patients, 78 had EORTC-MSG host factors and were classified accordingly, with EORTC-MSG criteria achieving 100% agreement in identifying clinical and histologically proven cases. In 112 ICU patients without EORTC-MSG host factors, overall agreement was 53% for FUNDICU, 4% for Asp-ICU, and 26% for Asp-ICU-BM versus the clinical cohort. Validation against histologically proven cases showed FUNDICU had 44% sensitivity and 75% specificity, Asp-ICU 6% sensitivity and 100% specificity, and Asp-ICU-BM 28% sensitivity and 63% specificity. Adding acute respiratory distress syndrome (ARDS) and post-cardiac surgery to the FUNDICU criteria improved sensitivity to 97% with a specificity of 63%. The remaining 12 patients lacked EORTC-MSG host factors and were not in the ICU, highlighting a novel classification system. CONCLUSIONS: EORTC-MSG and FUNDICU IPA classification systems are useful for the assignment of most patients with IPA. Incorporating postoperative complications after cardiac surgery and ARDS enhanced the diagnostic accuracy of FUNDICU.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Invasive Pulmonary Aspergillosis - diagnosis
- Male - administration & dosage
- Retrospective Studies - administration & dosage
- Female - administration & dosage
- Middle Aged - administration & dosage
- Algorithms - administration & dosage
- Aged - administration & dosage
- Intensive Care Units - administration & dosage
- Adult - administration & dosage
- Biomarkers - administration & dosage
- Find related publications in this database (Keywords)
- invasive pulmonary aspergillosis
- ICU
- host factors
- classification
- IPA