{ "abstract": "BackgroundViral pneumonia-associated pulmonary aspergillosis (VAPA) is a lethal complication in critically ill patients. We aimed to develop a generalizable and methodologically robust prediction tool for early VAPA risk, overcoming key limitations of existing models.MethodsIn a multi-center, ambispective cohort of 4,966 patients with influenza or COVID-19 admitted to ICU (Jan 2023–Jun 2025), we developed and validated two prediction models for VAPA using LASSO-selected variables: a standard Cox proportional hazards model and a Fine-Gray subdistribution hazards model accounting for non-VAPA death as a competing risk. For both models, restricted cubic splines were used to address nonlinear associations between continuous predictors and VAPA. Performance was assessed at 7 and 14 days post-ICU admission. Subgroup analysis was employed to examine the virus-specific models’ performance.ResultsThe incidence of VAPA was 8.8%. The Fine-Gray model demonstrated excellent discrimination and calibration in both derivation and validation cohorts. In contrast, the standard Cox model substantially overestimated VAPA risk, particularly among high-risk patients (by 20-30%). Key predictors included haematological malignancy, halo sign, use of priority antibiotic combinations, SOFA score, neutrophil-to-lymphocyte ratio (NLR), and pre-ICU corticosteroid dose; the latter three exhibited J-shaped associations with VAPA risk. A significant interaction was observed between viral subtype and pre-ICU corticosteroid dose (P = 0.006), with a stronger association in COVID-19 patients (sHR=1.17, 95% CI: 1.09-1.26). Overall model performance remained consistent across viral subtypes. An interactive web-based tool was then deployed, which generates both individualized VAPA risk estimates and corresponding clinical management recommendations.ConclusionsIn critically ill patients with viral pneumonia, a competing-risk model accounting for non-VAPA death provides more accurate estimates of VAPA risk than traditional approaches. The model demonstrates robust generalizability across influenza and COVID-19 pneumonia and offers a practical tool for early, personalized VAPA prediction.", "abstract_shown": true, "affiliations": [ "Respiratory Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China", "Infection Prevention and Control Department, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China", "Infection Prevention and Control Department, Henan Provincial Chest Hospital, Zhengzhou, China", "Infection Prevention and Control Department, The First Affiliated Hospital of Nanyang Medical College, Nanyang, China", "Infection Prevention and Control Department, The First Affiliated Hospital of Henan Medical University, Xinxiang, China", "Infection Prevention and Control Department, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China", "Infection Prevention and Control Department, Huaihe Hospital of Henan University, Kaifeng, China", "Infection Prevention and Control Department, Zhumadian Central Hospital, Zhumadian, China", "Infection Prevention and Control Department, Jiyuan People’s Hospital, Jiyuan, China", "0Central Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China", "1Department of Infectious Disease, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China", "2Department of Clinical Microbiology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China", "3Department of Infection Control, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China" ], "article_type": null, "arxiv": null, "author_total": 15, "authors": [ { "affs": [ 0 ], "name": "Jing Zhang" }, { "affs": [ 0 ], "name": "Shengnan Xu" }, { "affs": [ 1 ], "name": "Leilei Guo" }, { "affs": [ 2 ], "name": "Bo Qiao" }, { "affs": [ 3 ], "name": "Yuanyuan Li" }, { "affs": [ 4 ], "name": "Yansheng Zhou" }, { "affs": [ 5 ], "name": "Xiufeng Hu" }, { "affs": [ 6 ], "name": "Yanyan Guo" }, { "affs": [ 7 ], "name": "Bin Hu" }, { "affs": [ 8 ], "name": "Sangang Zheng" }, { "affs": [ 9 ], "name": "Chao Chen" }, { "affs": [ 0 ], "name": "Yajun Li" }, { "affs": [ 10 ], "name": "Junping Liu" }, { "affs": [ 11 ], "name": "Jiangfeng Zhang" }, { "affs": [ 12 ], "name": "Peng Li" } ], "bibtex": "https://research.draconitic.com/paper/03echmbfwwc5t.bib", "cited_by": 0, "doi": "10.3389/fcimb.2026.1956822", "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fcimb.2026.1956822/full", "id": "03echmbfwwc5t", "issns": [ "2235-2988" ], "landing_url": "https://doi.org/10.3389/fcimb.2026.1956822", "language": "en", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "lcc", "QR1-502" ], [ "openalex", "2725|Antifungal resistance and susceptibility" ] ], "openalex": "W7223843124", "pdf_url": "https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2026.1956822/pdf", "pmcid": null, "pmid": null, "published": "2026-10-27", "publisher": "Frontiers Media S.A.", "ris": "https://research.draconitic.com/paper/03echmbfwwc5t.ris", "sources": [ { "first_seen": "2026-10-31T14:21:48Z", "native_id": "0445b94953d84aaa8a97850e38ca4b34", "source": "doaj", "url": "https://doi.org/10.3389/fcimb.2026.1956822" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2725|Antifungal resistance and susceptibility", "subfield": "infectious-disease" } ], "title": "A novel predictive tool for pulmonary aspergillosis in critically ill patients with viral pneumonia: a multi-center, ambispective cohort study", "title_text": "A novel predictive tool for pulmonary aspergillosis in critically ill patients with viral pneumonia: a multi-center, ambispective cohort study", "type": "peer-reviewed", "updated_at": "2026-10-31T14:21:48Z", "url": "https://research.draconitic.com/paper/03echmbfwwc5t", "venue": "Frontiers in Cellular and Infection Microbiology", "versions": [] }