Invasive pulmonary aspergillosis real-world outcomes: Clinical features and risk factors associated with increased mortality.

Invasive pulmonary aspergillosis is a severe fungal infection that primarily affects immunocompromised patients and is associated with high mortality. Contemporary clinical characteristics of invasive pulmonary aspergillosis and "real world" estimates and predictors of associated mortality are inadequate. TriNetX, a global research network, was queried to identify adult patients with invasive pulmonary aspergillosis diagnosis based on the ICD-10 code B44.0. We performed a propensity score-matched analysis comparing clinical characteristics among patients who survived versus non-survivors at one year. We identified 4371 patients with invasive pulmonary aspergillosis. We found neoplasms, solid organ transplant recipients, hematologic malignancies, and aplastic anemia as the most predominant risk factors. The overall one-year mortality was 32% for invasive pulmonary aspergillosis. 1-year mortality for patients with COVID-19 in the ICU, with AML and aplastic anemia, and with neoplasms was 54%, 50%, and 39%, respectively. After propensity score matching, severe sepsis, pleural effusion, and candidiasis were mortality contributors within a year after diagnosis. Liver injury, systemic glucocorticoid exposure over the previous six months, lower lymphocyte and CD4 counts, elevated ferritin, LDH, thrombocytopenia, anemia, or elevated glycosylated hemoglobin (HbA1c) were independent predictors of mortality at one year. Voriconazole was the most common treatment (67%). The annual incidence of invasive pulmonary aspergillosis was 0.001%, increasing to 0.02% among critically ill patients in the ICU. Invasive pulmonary aspergillosis continues to have a very high mortality. We encourage prospective studies to validate and refine the identified clinical markers linked to increased mortality.