Influencing factors and clinical characteristics of severe fever with thrombocytopenia syndrome complicated with invasive pulmonary aspergillosis.

OBJECTIVE

To investigate the clinical characteristics and risk factors of invasive pulmonary aspergillosis (IPA) in patients with severe fever with thrombocytopenia syndrome (SFTS).

METHODS

We conducted a retrospective analysis of 136 SFTS patients hospitalized at Zhongnan Hospital of Wuhan University between January 2017 and May 2024. Patients were stratified into IPA (n = 33) and non-IPA (n = 103) groups. Demographics, comorbidities, laboratory parameters, interventions, and outcomes were compared. Univariate and multivariate analyses were employed to evaluate the influencing factors, and Kaplan-Meier curves were utilized to assess survival outcomes.

RESULTS

Compared to the non-IPA group, the IPA group was associated with significantly higher rates of severe disease (93.94% vs. 43.69%, P < 0.001), mortality (42.42% vs. 6.80%, P < 0.001) and ICU admission (63.64% vs. 17.48%, P < 0.001). Survival analysis revealed a significantly lower survival rate than that of the non-IPA group. Patients with IPA were older (69 vs. 65 years, P = 0.026) and more likely to have pre-existing diabetes (27.27% vs. 8.74%, P = 0.006) or hypertension (45.45% vs. 23.30%, P = 0.014). Laboratory analyses demonstrated significantly elevated markers of multi-organ damage in IPA group, including hepatic (ALT, AST, albumin), cardiac (Troponin I, CK, CK-MB), Pancreas (amylase, lipase) and renal (Creatinine) dysfunction indicators (P < 0.05), along with heightened inflammatory responses evidenced by increased IL-6 (P < 0.001), PCT (P < 0.001) and CRP (P = 0.038) levels. Immunological assessment revealed profound lymphocyte depletion in IPA group, particularly affecting CD4⁺ T cells (124 vs. 324 cells/µL), CD8⁺ T cells (86.5 vs. 327 cells/µL), and NK cells (40.5 vs. 139.5 cells/µL) (all P < 0.001). Notably, IPA patients exhibited substantially higher viral loads (208,000 vs. 3,535 copies/mL, P < 0.001). Multivariate analysis identified diabetes (OR [5.809], P = 0.013) and severe disease at admission (OR [7.111], P = 0.022) as independent risk factors for IPA development.

CONCLUSION

IPA profoundly impairs clinical outcomes in SFTS patients, emphasizing the importance of early identification and immediate therapeutic intervention. Particular vigilance should be maintained for high-risk populations, including diabetic patients and those with severe SFTS manifestations, through intensified surveillance and rapid antifungal therapy to mitigate mortality and improve prognostic trajectories. CLINICAL TRIAL NUMBER: Not applicable.