Background Invasive pulmonary aspergillosis (IPA), once limited to immunocompromised patients, is now a severe complication in critically ill ICU patients without classic risk factors. Due to the difficulty of obtaining histological evidence, its diagnosis relies on poorly tested algorithms in real-world settings. Methods We conducted a retrospective multicenter (n=9) cohort study including 202 patients with IPA. Patients were classified using a multistep process based on the European Organization for the Research and Treatment of Cancer/Mycosis Study Group (EORTC-MSG), Invasive-Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU), Aspergillus ICU (Asp-ICU), and Asp-ICU with biomarkers (Asp-ICU-BM) criteria. We then evaluated the predictive performance of these criteria against the clinical cohort and histologically proven cases. Results Among 202 patients, 78 had EORTC-MSG host factors and were classified accordingly, with the EORTC-MSG criteria achieving 100% agreement in identifying clinical and histologically proven cases. In 112 ICU patients without EORTC-MSG host factors, overall agreement was 53% for FUNDICU, 4% for Asp-ICU, and 26% for Asp-ICU-BM compared to the clinical cohort. Validation against histologically proven cases showed FUNDICU had 44% sensitivity and 75% specificity, Asp-ICU 6% sensitivity and 100% specificity, and Asp-ICU-BM 28% sensitivity and 63% specificity. Adding acute respiratory distress syndrome (ARDS) and post-cardiac surgery to the FUNDICU criteria improved sensitivity to 97% with a specificity of 63%. The remaining 12 patients lacked EORTC-MSG host factors and were not in the ICU, highlighting a novel classification system. Conclusion EORTC-MSG and FUNDICU IPA classification systems are useful for the assignment of most patients with IPA. Incorporating post-operative complications after cardiac surgery and ARDS enhanced the diagnostic accuracy of FUNDICU.

中文翻译：

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侵袭性肺曲霉病患者诊断流程的性能


背景 侵袭性肺曲霉病 （IPA） 曾经仅限于免疫功能低下的患者，现在是没有典型危险因素的危重 ICU 患者的严重并发症。由于难以获得组织学证据，其诊断依赖于在现实世界中测试不佳的算法。方法 我们进行了一项回顾性多中心 （n=9） 队列研究，包括 202 例 IPA 患者。根据欧洲癌症研究与治疗组织/蕈样病研究组 （EORTC-MSG）、重症监护病房成年患者的侵袭性真菌病 （FUNDICU）、曲霉菌 ICU （Asp-ICU） 和具有生物标志物的 Asp-ICU （Asp-ICU-BM） 标准，使用多步骤过程对患者进行分类。然后，我们根据临床队列和组织学证实的病例评估了这些标准的预测性能。结果 在 202 例患者中，78 例存在 EORTC-MSG 宿主因素并进行相应分类，EORTC-MSG 标准在识别临床和组织学证实的病例方面达到 100% 一致性。在112例无EORTC-MSG宿主因素的ICU患者中，与临床队列相比，FUNDICU的总体一致性为53%，Asp-ICU的总体一致性为4%，Asp-ICU-BM的总体一致性为26%。对组织学证实的病例的验证显示，FUNDICU 的敏感性为 44%，特异性为 75%，Asp-ICU 的敏感性为 6%，特异性为 100%，Asp-ICU-BM 的敏感性为 28%，特异性为 63%。在 FUNDICU 标准中加入急性呼吸窘迫综合征 （ARDS） 和心脏手术后，敏感性提高到 97%，特异性为 63%。其余 12 例患者缺乏 EORTC-MSG 宿主因子，未在 ICU 中，突出了一种新的分类系统。 结论 EORTC-MSG 和 FUNDICU IPA 分类系统有助于大多数 IPA 患者的分配。纳入心脏手术和 ARDS 后的术后并发症提高了 FUNDICU 的诊断准确性。