A Serum Galactomannan and Neutrophil-to-Lymphocyte Ratio-Based Nomogram for Predicting In-Hospital Mortality in Non-Neutropenic Invasive Pulmonary Aspergillosis

Xinyu Wang¹Wenjuan Li²Yunyu Ma³Yi Li³Shenyan Ding¹Jiayi Shen⁴Tingting Zhao¹Yajie Lu¹Chao Sun⁵Xin Su^1*

• ¹Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
• ²Center for Medical Big Data, Nanjing Drum Tower Hospital, Nanjing, China
• ³Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
• ⁴Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
• ⁵Department of Respiratory and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

Background: We developed a novel prognostic model combining serum galactomannan (GM) and neutrophil-to-lymphocyte ratio (NLR) for predicting in-hospital mortality in non-neutropenic invasive pulmonary aspergillosis (IPA). Methods: We retrospectively identified 278 eligible IPA patients using the automated natural language processing system. Patients were divided into survival (n=199) and non-survival (n=79) groups. A multivariate logistic regression was developed to predict in-hospital mortality based on age, critical condition, serum GM and NLR. Internal validation was performed using bootstrap resampling methods. Subsequently, a clinical nomogram was constructed to support clinical decision-making. Results: Serum GM exhibited a higher specificity of 78.9% (95% CI: 72.6–84.3%), whereas NLR demonstrated relatively greater sensitivity at 70.9% (95% CI: 59.6– 80.6%) for mortality prediction. The combination of either positive exhibited a sensitivity of 81.0%, while the dual-positive criterion achieved a specificity of 90.5%. A comprehensive model integrating age, critical condition, serum GM, and NLR demonstrated robust discrimination, with a mean AUC of 0.815 (SD = 0.005) after bootstrap resampling with 1000 iterations. This result was consistent with the original model AUC of 0.818 (95% CI: 0.767-0.870). Decision curve analysis further confirmed that the comprehensive model provided a greater net benefit compared to the simple model based solely on age and critical condition, highlighting the clinical utility of including serum GM and NLR as biomarkers in decision-making processes. Conclusion: Our study provided novel evidence that the synergistic integration of mycological (serum GM) and inflammatory biomarkers (NLR) significantly improves prognostic accuracy in non-neutropenic IPA. The developed clinical nomogram offers a practical tool to support clinical decision-making.