Epidemiology of and Risk Factors Associated with Mortality from Invasive Pulmonary Fungal Infection in Non-Neutropenic Patients in China: A 10-Year Retrospective Study

The mortality rate associated with invasive pulmonary fungal infection (IPFI) is substantial, whereas epidemiological data pertaining to non-neutropenic patient cohorts is deficient. This study aims to analyze the epidemiology and identify risk factors associated with mortality from invasive pulmonary fungal infection in non-neutropenic populations. A retrospective study was conducted encompassing adult patients diagnosed with IPFI at the First Affiliated Hospital of Sun Yat-sen University between January 1, 2013, and December 31, 2022. A total of 513 patients were included in the study, and their survival information was retrospectively collected. A comparison of IPFI patient demographics between 2013-2017 and 2018-2022 revealed a marked elevation in the median age and a significant increase in the prevalence of comorbidities, including hypertension, hematological malignancies, and bronchiectasis. There was a notable shift in the prevalence of fungal pathogens, marked by an elevation in the proportion of individuals afflicted with Pneumocystis jirovecii. The 30-day mortality rate for IPFI patients remained relatively stable compared with the previous 5 years (11.71% versus 16.02%, P = 0.275). The Cox multivariate regression analysis revealed that intensive care unit admission (P <0.001), repeated blood transfusions (P = 0.042), and Aspergillus infection (P = 0.001) may be independent risk factors for all-cause mortality, respectively. A nomogram predicting 30-day all-cause mortality among patients with IPFI demonstrated satisfactory performance in terms of classification ability and calibration ability. These findings will contribute to better management of patients with IPFI by preventing the identified risk factors.