Diagnosis, management, and clinical outcomes of childhood invasive aspergillosis.
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OBJECTIVE: To present our clinical experience in pediatric invasive aspergillosis and to identify independent risk factors and prognostic thresholds affecting survival. MATERIALS AND METHODS: We retrospectively reviewed 30 pediatric patients diagnosed with proven or probable invasive aspergillosis at a tertiary care center between 2012 and 2025. Demographic, clinical, radiological, and laboratory data were analyzed. Receiver Operating Characteristic (ROC) curve analysis was performed to identify optimal prognostic cut-offs for laboratory markers. Multivariate logistic regression was used to identify independent associates of mortality while addressing the risk of overfitting. RESULTS: Thirty patients were included (56.7% male; median age 114.5 months). The most common underlying diseases were hemato-oncological malignancies (53.4%), immunodeficiencies (23.3%), and non-malignant hematological diseases (23.3%). Fifteen patients (50%) were diagnosed with proven IA and 15 (50%) with probable IA. Neutropenia was seen in 22 patients (73.3%) and lymphopenia in 29 (96.7%). Crude and attributable mortality rates were 40% (n = 12) and 13.3% (n = 4), respectively. ROC analysis identified critical thresholds for mortality: ferritin > 3479 ng/mL (AUC: 0.823, p = 0.019), procalcitonin > 7.3 ng/mL (AUC: 0.745, p = 0.025), and absolute monocyte count < 0.01 × 10³/µL (AUC: 0.678, p = 0.048). In this cohort, multivariate analysis indicated that higher baseline ferritin levels were independently associated with increased mortality (OR: 1.12, 95% CI: 1.01-1.26, p = 0.038). However, hyperferritinemia was significantly more pronounced in patients with aplastic anemia (p = 0.001). CONCLUSION: Early diagnosis and aggressive antifungal therapy appear effective in limiting invasive aspergillosis attributable mortality. The integration of specific laboratory thresholds, particularly high ferritin and profound monocytopenia, may offer valuable insights for risk stratification in pediatric invasive aspergillosis. Future multicenter studies are warranted to validate these findings.