Association of Diabetes Mellitus and Malnutrition with Aspergillus IgG and Chronic Pulmonary Aspergillosis in Pulmonary Tuberculosis Patients: A Retrospective Study

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Purpose: To examine the association of diabetes mellitus (DM) and nutritional status with the levels of Aspergillus IgG and diagnosis of chronic pulmonary aspergillosis (CPA) in patients with pulmonary tuberculosis. Patients and methods: This retrospective study included hospitalized patients with pulmonary tuberculosis who received Aspergillus IgG testing at the Fifth People’s Hospital of Suzhou between February 2019 and August 2023. The patients were divided into DM and non-DM groups based on established diagnostic markers, including fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), or the clinical history of antidiabetic treatments. DM, body mass index (BMI), serum albumin, blood Aspergillus IgG, and CPA diagnostic information were collected from the patient charts. Results: This study included 1087 patients, including 188 who had DM. The overall proportion of patients diagnosed with CPA was 9.6% (17.6% in DM vs. 7.9% in non-DM). The overall detection rate of Aspergillus IgG > 80 AU/mL was 24.1% (25.5% in DM vs. 23.8% in non-DM). The multivariable analysis showed that BMI < 18.5 kg/m 2 (OR=1.827, 95% CI: 1.160– 2.876, p=0.009), DM (OR=2.718, 95% CI: 1.694– 4.361, p< 0.001), obsolete pulmonary tuberculosis (OR=4.644, 95% CI: 2.658– 8.115, p< 0.001), and albumin < 35 g/L (OR=1.943, 95% CI: 1.264– 2.987, p=0.002) were independently associated with CPA. Furthermore, the proportion of confirmed CPA in those with DM and/or BMI < 18.5 kg/m 2 was higher than in non-DM patients with BMI < 18.5 kg/m 2 (15.3% vs. 5.8%, p< 0.001), while the rate in the DM and/or albumin < 35 g/L group was higher than the non-DM with albumin ≥ 35 g/L group (14.9% vs.5.9%, p< 0.001). Conclusion: BMI < 18.5 kg/m 2 , DM, obsolete pulmonary tuberculosis, and albumin < 35 g/L were independently associated with CPA in patients hospitalized for tuberculosis. Screening and early intervention for CPA should be strengthened in this high-risk population. Keywords: pulmonary tuberculosis, diabetes mellitus, malnutrition, Aspergillus IgG, pulmonary aspergillosis, body mass index, serum albumin, diagnostic threshold

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