Mortality in Invasive Aspergillosis with Kidney Disease: Clinical Severity and Bronchoalveolar Lavage Culture in a 19-Year Cohort

Background: Invasive aspergillosis (IA) carries high mortality, yet outcomes in patients with concomitant kidney disease are poorly characterized. We examined mortality and pragmatic clinical and mycological markers in hospitalized adults with both conditions. Methods: We retrospectively evaluated 88 adults hospitalized from 2002 to 2020 with proven or probable IA and kidney disease. Renal status was re-adjudicated into four mutually exclusive phenotypes; acute renal replacement therapy (RRT) was recorded separately. qSOFA was assessed at IA diagnosis. Bronchoalveolar lavage (BAL) fungal culture results were available for all 88 patients. In-hospital outcome was defined at discharge, and long-term follow-up was assessed from the index admission. Results: In-hospital mortality was 58.0% (51/88); 25 (28.4%) and 24 (27.3%) patients were documented alive at 1 and 2 years, respectively. Renal phenotypes were maintenance dialysis/end-stage kidney disease requiring long-term dialysis in 24 (27.3%), chronic kidney disease (CKD)CKD without acute kidney injury (AKI) in seven (8.0%), AKI without documented pre-existing CKD in 28 (31.8%), and AKI-on-CKD in 29 (33.0%); 26/64 non-maintenance-dialysis patients (40.6%) received acute RRT. qSOFA ≥ 2 occurred in 98.0% of nonsurvivors versus 40.5% of survivors (p < 0.001). BAL Aspergillus culture was positive in 30/88 (34.1%) and more frequent among nonsurvivors (45.1% vs. 18.9%; p = 0.013). A. fumigatus was the most frequently recorded BAL species (19/30, including mixed cultures). qSOFA ≥ 2 and BAL culture positivity were associated with in-hospital and 2-year mortality in exploratory adjusted analyses. Conclusions: Adults hospitalized with IA and kidney disease had poor outcomes. Acute physiologic severity and BAL Aspergillus culture provided complementary prognostic information, while renal re-phenotyping demonstrated marked host heterogeneity. Contemporary validation is needed.