Risk Factors Associated with Invasive Pulmonary Mycosis Among Severe Influenza Patients in Beijing City, China

OBJECTIVE: Influenza co-infection with fungal infection increases the risk of death. Our study was to estimate risk factors associated with invasive pulmonary mycosis (IPM) among severe influenza patients at a single center in Beijing, China. METHODS: A retrospective chart review was carried out of all patients with severe influenza admitted to respiratory the department including the respiratory intensive care unit (RICU) during the 2014 to 2019 influenza seasons in Beijing Chao-yang hospital, China. We compared the differences of characteristics and examination outcomes between IPM patients and non-IPM patients, and explored the predictors of IPM by a multivariate logistic regression. RESULTS: Influenza associated IPM was found in 65 of 131 (49.62%) patients. The average age of IPM patients was 57.28±14.56 years and 70.77% were male. The mortality rate was much higher in the IPM group than the non-IPM group (34.85% versus 18.46%, P=0.026). Older age, hypoimmunity, liver disease, hypertension, positive serum GM test, steroids using, gasping, gastrointestinal symptoms, high APECHEII, low oxygenation index, other viruses co-infection, bacterial co-infection, low lymphocyte counts, low CD4+ T-cell counts, low CD8+ T-cell counts, low RBC, low hemoglobin, low platelets, high N%, low total protein, high CRP, low albumin, low fibrinogen, high BUN, positive serum GM test, more mechanical ventilation requirement, and more renal replacement requirement were risk factors of influenza IPM co-infection. CONCLUSION: IPM is a severe complication of influenza hospitalizations. It is associated with increasing mortality, longer hospital stays, and higher hospital charges compared with non-IPM patients. Clinicians caring for patients with severe influenza should consider IPM.