Performance of Diagnostic Algorithms in Patients With Invasive Pulmonary Aspergillosis.

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pulmonology

Background:

• Invasive pulmonary aspergillosis (IPA) is increasingly recognized in critically ill ICU patients, often lacking traditional risk factors.
• Accurate diagnosis of IPA is difficult due to challenges in obtaining histological confirmation.
• Current diagnostic algorithms for IPA are not well-validated in real-world ICU settings.

Purpose of the Study:

• To evaluate the performance of existing classification systems for Invasive pulmonary aspergillosis (IPA) in a cohort of critically ill patients.
• To assess the utility of modified criteria for improving IPA diagnosis in intensive care unit (ICU) patients.

Main Methods:

• A retrospective multicenter cohort study involving 202 patients with IPA.
• Classification of patients using European Organization 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 Aspergillus-ICU with biomarkers (Asp-ICU-BM) criteria.
• Evaluation of diagnostic performance against clinical and histologically proven IPA cases.

Main Results:

• The EORTC-MSG criteria showed 100% agreement for patients with EORTC-MSG host factors.
• For ICU patients without EORTC-MSG factors, agreement was 53% for FUNDICU, 4% for Asp-ICU, and 26% for Asp-ICU-BM.
• Modified FUNDICU criteria, incorporating acute respiratory distress syndrome (ARDS) and post-cardiac surgery, significantly improved sensitivity to 97% with 63% specificity.

Conclusions:

• Existing Invasive pulmonary aspergillosis (IPA) classification systems like EORTC-MSG and FUNDICU are valuable for patient stratification.
• Enhancing the FUNDICU criteria with ARDS and postoperative cardiac surgery complications significantly improves diagnostic accuracy in ICU settings.
• A novel classification system may be needed for patients lacking EORTC-MSG host factors and not in the ICU.