Phase characteristics and risk factors of acute-on-chronic liver failure with invasive pulmonary aspergillosis

The incidence of Invasive pulmonary aspergillosis (IPA) in acute-on-chronic liver failure (ACLF) population is increasing, and its diagnosis and treatment is still a major clinical conundrum. This study aimed to characterize disease-stage-specific patterns and identify independent risk factors for IPA development in ACLF. A cohort of 835 ACLF patients (Jan 2014-Aug 2023) was retrospectively analyzed. IPA diagnosis followed Invasive Fungal Infections Group of the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG). Comparative analysis included 55 ACLF-IPA cases versus 163 pulmonary infection controls without IPA. Multivariate logistic regression established risk factors, with predictive performance evaluated by ROC analysis. The rate of clinical diagnosis of IPA in 835 ACLF patients was 6.6% (55/835). The median interval from ACLF diagnosis to IPA diagnosis was 31 days. The logistic regression model was C-Aged = 1.531 × [cirrhosis (yes:1, no:0)] + 1.511 × [diabetes mellitus (yes:1, no:0)] + 0.811 × [steroid exposure (yes:1, no:0)] + 0.033 × age + 1.520 × [types of broad-spectrum antibiotics ≥ 3 (yes:1, no:0)] -6.155. The derived predictive model demonstrated strong discrimination (AUROC = 0.828). IPA predominantly manifests in advanced ACLF stages (≥ 28 days). Critical risk factors include cirrhosis, diabetes, glucocorticoid use, advanced age, and multi-class antibiotic exposure. These findings enable risk-stratified surveillance and early intervention.