Relationship Between Invasive Fungal Infection and Hypostatic Pneumonia: A Prospective Cohort Study
Lin Liu1, Chang Liu1, Jianrong Cai2
1School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The short-term mortality of hypostatic pneumonia (HP) is very high, and the treatment outcome is poor. The clinical diagnosis and treatment are primarily focused on bacterial and viral infection, ignoring the role of fungal infection at present. This study aims to validate the relationship between Invasive Fungal Infections (IFI) and HP.
Methods:
In the cross-sectional study, a total of 11,371 participants have been enrolled. In the prospective cohort study, 4,441 individuals have been included at baseline and followed up from 2015 to 2019 with a total person years of 8,484.65. The standard procedures were used to assess questionnaire investigations, laboratory testing, and anthropometric indicators. For data analysis, logistic regression, restricted cubic spline, log-rank regression, Cox regression, and linear mixed effects model were applied to assess the relationship between IFI and HP risk longitudinally.
Results:
In the cross-sectional study, elevated β-D-Glucan (BDG) concentrations are associated with a higher risk of HP prevalence in the total population, men, and women (OR . [95% CIs]: 2.12 [1.55, 2.91]; 2.01 [1.35, 2.99]; 2.34 [1.39, 3.94]), which were verified by a dose-effect relationship in the restricted cubic spline model. In the cohort study, Cox and Log-rank regression showed that the elevated BDG concentrations are associated with a significantly higher risk of HP incidence than participants with lower BDG concentrations (HR .T1 [95% CIs]: 2.72 [1.36, 5.43], p = 0.0086). During 5 years, the globulin (GLB) and C-reactive protein (CRP) were always on the top in the highest category of BDG concentrations. Between low and high BDG concentration, the total trend of GLB concentration was falling and the total trend of CRP concentration was rising with the increase of years (all the p-values < 0.0001).
Conclusion:
In this study, IFI is associated with a higher risk of HP, with time sequence and related mechanisms requiring further investigation in the future.
Insights
Invasive fungal infections (IFI) are linked to a higher risk of hypostatic pneumonia (HP). Elevated beta-D-Glucan (BDG) levels indicate increased HP prevalence and incidence, suggesting fungi play a role in this condition.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Hypostatic pneumonia (HP) has high short-term mortality and poor treatment outcomes.
- Current clinical focus on bacterial and viral infections overlooks potential fungal contributions.
- Invasive Fungal Infections (IFI) may play a significant role in HP development.
Purpose of the Study:
- To investigate the association between Invasive Fungal Infections (IFI) and hypostatic pneumonia (HP).
- To determine if fungal biomarkers predict HP risk.
- To explore potential mechanisms linking IFI and HP.
Main Methods:
- Cross-sectional study of 11,371 participants and a prospective cohort study of 4,441 individuals (2015-2019).
- Assessment of questionnaire data, laboratory tests, and anthropometric indicators.
- Statistical analysis including logistic regression, restricted cubic splines, log-rank, Cox regression, and linear mixed effects models.
Main Results:
- Elevated beta-D-Glucan (BDG) concentrations correlated with higher HP prevalence (OR 2.12) and incidence (HR 2.72).
- A dose-effect relationship was observed between BDG levels and HP risk.
- Globulin and C-reactive protein levels showed distinct trends in relation to BDG concentrations over time.
Conclusions:
- Invasive fungal infections are associated with an increased risk of hypostatic pneumonia.
- Elevated BDG levels serve as a potential biomarker for HP risk.
- Further research is needed to elucidate the temporal relationship and mechanisms involved.
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