Concurrent pretreatment serum and BALF galactomannan positivity as a prognostic indicator in non-neutropenic invasive pulmonary aspergillosis without malignancy or solid organ transplantation: a retrospective cohort study.

Background: The prognostic evaluation of invasive pulmonary aspergillosis (IPA) in non-neutropenic patients remains clinically challenging. While galactomannan (GM) testing in serum and bronchoalveolar lavage fluid (BALF) aids in diagnosis, the prognostic significance of concurrent positivity in both compartments is not well-established. This study aimed to determine whether concurrent pretreatment GM positivity serves as an independent predictor of 30-day all-cause mortality in non-neutropenic IPA patients without underlying malignancy or solid organ transplantation. Methods: We conducted a single-center, retrospective cohort study including 162 patients with proven or probable IPA admitted between February 2018 and February 2025. Patients were stratified into two groups based on stringent, predefined criteria: the GM-positive group (concurrent pretreatment serum GM index ≥ 0.7 and BALF GM index ≥ 0.8, Results: The overall 30-day mortality was 29.6% (48/162). Mortality was significantly higher in the GM-positive group compared to the GM-negative group (45.7% vs. 13.6%, Conclusion: In non-neutropenic IPA patients without classic immunocompromising conditions (e.g., malignancy or solid organ transplantation), concurrent pretreatment positivity for both serum and BALF GM is an independent prognostic marker for increased 30-day all-cause mortality. This combined assessment may serve as a valuable tool for early risk stratification, potentially helping to identify a high-risk subgroup that could benefit from more vigilant monitoring and individualized management strategies.