Epidemiology, Risk Factors, and Routine Blood Biomarkers of Aspergillosis in Cancer Patients in Jiangxi, China

Aspergillosis is a serious public health concern worldwide; however, its epidemiology and clinical predictors remain poorly characterized among cancer patients in China, particularly in regions such as Jiangxi, where regional data are limited. This study aimed to evaluate the epidemiology, risk factors, and potential utility of routine inflammatory biomarkers in distinguishing Aspergillus colonization from infection in this population.

In the current retrospective study, the epidemiology, risk factors, and blood biomarkers of Aspergillus cases among cancer patients at Jiangxi Cancer Hospital in Nanchang, China, were investigated from 2021 to 2025.

There were 354 cases in all, with 14.1% colonization, 43.5% possible infections, and 42.4% probable infections. Almost half of the patients had underlying lung cancer (n = 161, 45.48%), and Aspergillus fumigatus (n = 313, 88.42%) was the most frequently detected species. The use of steroids (OR 18.16, p < 0.001), chemotherapy (OR 5.41, p = 0.003), and high glucose levels (OR 1.68, p = 0.02) were shown to be independent risk factors for infection in all cancer populations. In lung cancer patients, smoking (OR 4.11, p < 0.001), chronic obstructive pulmonary disease (COPD) (OR 3.83, p = 0.02), and steroid usage (OR 3.06, p = 0.03) were independently related to higher infection risk. Biomarker analysis revealed that probable infection was associated with higher neutrophil and white blood cell (WBC) counts, a higher neutrophil-to-lymphocyte ratio (NLR), and metabolic markers, including glucose and creatinine. Principal component analysis (PCA) demonstrated distinct clustering driven by inflammatory signatures.

This study provides comprehensive epidemiological data on aspergillosis in a large cohort of cancer patients in Jiangxi, China, and highlights the potential value of routinely available inflammatory markers in differentiating colonization from infection. These findings may support early risk stratification and improve clinical decision-making, particularly in resource-limited settings where advanced fungal diagnostics are not readily available.