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Longitudinal mycological profiling of influenza-associated and COVID-19-associated pulmonary aspergillosis

Valentine Delanote1,2, Jannes Heylen1,3, Hanne Moon Lauwers1

  • 1Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.

Critical Care (London, England)
|January 8, 2026
PubMed
Abstract

Insights

Longitudinal bronchoalveolar lavage galactomannan (BAL GM) dynamics can predict outcomes in patients with influenza- or COVID-19-associated pulmonary aspergillosis (IAPA/CAPA). Rising BAL GM levels indicate a higher risk of mortality in critically ill patients.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Mycology

Background:

  • Influenza- and COVID-19-associated pulmonary aspergillosis (IAPA/CAPA) significantly increase mortality risk in critically ill patients.
  • Predictive biomarkers for IAPA/CAPA outcomes are crucial for timely clinical intervention.

Purpose of the Study:

  • To evaluate the predictive value of longitudinal bronchoalveolar lavage (BAL) galactomannan (GM) dynamics for clinical outcomes in patients with IAPA and CAPA.
  • To assess the association between BAL GM trends and mortality in mechanically ventilated patients with viral-associated pulmonary aspergillosis.

Main Methods:

  • Retrospective cohort study of 180 adult patients with IAPA (n=68) or CAPA (n=112) in a tertiary care ICU (2009-2024).
  • Analysis of 698 BAL samples using linear mixed-effects models and Bayesian joint models to assess GM dynamics and time-to-death.
  • Correlation of Aspergillus culture dynamics with patient outcomes.

Main Results:

  • BAL GM values showed significant decline over time, with steeper reductions observed in survivors (p<0.05).
  • Each unit increase in BAL GM over time corresponded to a 19% higher hazard of death at 30 and 90 days (aHR 1.19).
  • Persistent positive Aspergillus cultures in BAL were associated with poorer clinical outcomes.

Conclusions:

  • Longitudinal BAL GM kinetics serve as a potential prognostic biomarker in virus-associated pulmonary aspergillosis.
  • Early and sustained increases in BAL GM levels identify critically ill patients at elevated risk of mortality.
  • BAL GM monitoring can aid in risk stratification and management decisions for IAPA and CAPA.

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