Influenza-associated invasive aspergillosis in the intensive care unit (ICU): a prospective, multicentre cohort study
Authors' conclusion
We demonstrate prospectively that IAPA is a frequent complication in critically ill patients with influenza and that it is associated with high mortality and an adverse clinical course
Study context
- Population
- Adults admitted to ICU with respiratory distress, Netherlands and Belgium, three influenza seasons (2017–2020)
- Participants
- 140 vs 76
- Exposure
- Influenza vs non-influenza community-acquired pneumonia
- Influenzan = 140
- Non-influenza community-acquired pneumonia (niCAP)n = 76reference
- Outcome
- Incidence of invasive aspergillosis (IAPA per 2020 expert opinion case definition)
Methodological detailsmulticentre, observational, Diagnosis of niCAP and mycological work-up at treating physicians' discretion
- Multicentre
- Observational
- Diagnosis of niCAP and mycological work-up at treating physicians' discretion
Main finding
As reported in the abstract
Invasive aspergillosis
P = 0.054
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| IAPA as independent predictor of ICU mortality in influenzaIAPA vs Influenza without aspergillosis | 1.99 (1.05–3.76) | P = 0.035 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
| Outcome | Influenza | niCAP | P value |
|---|---|---|---|
| EORTC/MSGERC host factors, IAPA vs influenza alone | 26% | — not stated in the abstract | P = 0.82 |
| Invasive ventilatory support in ICU, IAPA vs influenza alone | 57% | — not stated in the abstract | P = 0.001 |
| RRT in ICU, IAPA vs influenza alone | 13% | — not stated in the abstract | P < 0.001 |
| ICU mortalityIAPA vs Influenza without aspergillosis | — not stated in the abstract | 17% | P < 0.001 |
— not stated in the abstract
- Time to influenza-associated pulmonary aspergillosis (IAPA) diagnosis after ICU admission: IAPA median 4 days
- EORTC/MSGERC host factors, IAPA vs influenza alone: IAPA 28%
- EORTC/MSGERC host factors, IAPA vs influenza alone: denominators 32 and 85
- Invasive ventilatory support in ICU, IAPA vs influenza alone: IAPA 90%
- Invasive ventilatory support in ICU, IAPA vs influenza alone: denominators 29 and 88
- RRT in ICU, IAPA vs influenza alone: IAPA 45%
- RRT in ICU, IAPA vs influenza alone: denominators 33 and 103
- ICU mortality: IAPA 44%
- ICU mortality: Influenza without aspergillosis 14%
Non-survivors vs survivors with IAPA: male sex and systemic corticosteroids in ICU
- Male: 13/15 [87%] non-survivors vs 9/19 [47%] survivors
- P = 0.030
- Systemic corticosteroids: 14/15 [93%] non-survivors vs 10/19 [53%] survivors
- P = 0.020
Original publication
Influenza-associated invasive aspergillosis in the ICU: a prospective, multicentre cohort study. Crit Care. Published 29 November 2025. doi:10.
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