Clinical and Microbiological Characteristics of Pulmonary Aspergillosis in Elderly vs Non-Elderly Patients: A tNGS-Based Retrospective Study

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Background: Elderly patients are more susceptible to pulmonary aspergillosis(PA) and exhibit worse clinical outcomes. This study aims to compare the clinical characteristics, pathogen distribution, co-infection patterns, and outcomes of elderly and non-elderly patients with PA diagnosed via targeted next-generation sequencing (tNGS). Methods: This retrospective study included 107 patients with tNGS-confirmed pulmonary aspergillosis admitted to Ruijin Hospital between March 2023 and January 2025. Demographic, clinical, radiological, and laboratory data were extracted from electronic medical records to compare the clinical and microbiological profiles between the elderly (≥ 65 years) and non-elderly (< 65 years) cohorts. Results: A total of 107 patients including elderly (n=64) and non-elderly (n=43) were included retrospectively. The prevalence of invasive pulmonary aspergillosis was significantly higher in the elderly group compared to the non-elderly group (93.8% vs 74.4%). Similarly, the elderly group had significantly higher proportions of overall co-infection (79.7% vs 51.2%), bacterial co-infection (68.8% vs 39.5%), and atypical imaging features such as patchy infiltrates/consolidation (89.1% vs 62.8%) (all P < 0.05). Furthermore, the elderly exhibited significantly lower lymphocyte and albumin levels, and higher D-dimer levels ( P < 0.05). Mortality was also significantly higher among elderly patients (18.8% vs 4.7%; P = 0.042). Conclusion: Within our study scope, pulmonary aspergillosis in the elderly is characterized by higher mortality, atypical imaging, prevalent bacterial co-infections, and specific laboratory deviations—most notably, diminished lymphocytes and albumin alongside elevated D-dimer and LDH levels. Furthermore, tNGS serves as a valuable adjunctive tool to identify complex mixed pathogens and assist in clinical management. Keywords: pulmonary aspergillosis, targeted next-generation sequencing, tNGS, elderly, co-infection

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