Supplementary file 1_Detection of Aspergillus in the lower respiratory tract and its association with mortality in patients with different viral pneumonias: a retrospective multicenter cohort study from China.docx

The detection rates differed significantly across viral etiologies (33.2% in patients with influenza, 14.6% in those with SARS-CoV-2, and 7.4% in those with other viruses; P < 0.001). In the fully adjusted model, Aspergillus detection was independently associated with increased overall mortality (aOR = 2.99; 95% CI 1.60–5.58; P < 0.001), but the association varied markedly by viral etiology. Virus-stratified analyses revealed that in influenza, Aspergillus detection remained independently associated with mortality after multivariable adjustment, and the association was consistently observed across prespecified subgroups, including non-ventilated patients, whereas in SARS-CoV-2, the association was largely confined to ventilated patients.</p>Conclusion<p>Lower respiratory tract Aspergillus detection differed substantially by viral etiology and was most frequent in patients with influenza pneumonia.

It was independently associated with increased mortality across all influenza subgroups, including non-ventilated patients, whereas in SARS-CoV-2 pneumonia this association was largely confined to mechanical ventilation patients. These findings support a virus-stratified approach to fungal surveillance and warrant prospective validation.</p>