Confronting the “lethal duo” in the ICU: early identification of Aspergillus–Mucorales co-infection using a clinical-immuno-inflammatory signature

Background: in the intensive care unit (ICU) represents a devastating syndrome with high mortality that is frequently clinically occult. Clinically distinguishing this co-infection from invasive pulmonary aspergillosis (IPA) is challenging but critical for tailoring precise antifungal strategies. Methods: infection and 18 with co-infection) admitted between 2017 and 2025. We compared clinical characteristics, inflammatory markers, and immunophenotypes between groups. A three-stage variable selection strategy integrating univariable regression pre-screening, multi-algorithm importance ranking (LASSO, Ridge, and Random Forest), and clinical applicability filtering was employed to identify predictors for a multivariable logistic regression nomogram. Results: = 0.849) and stability on internal validation (cross-validated AUC = 0.860). Conclusion: -active therapy to improve prognosis.