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Star Research Presentations: Research

Improving Capture of Invasive Fungal Disease and Outcomes in the ICU: A Retrospective Cohort Study

Monday, March 23, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central Theater 1
  • BB

    Brittany Badesch, MD

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • MW

    Morgan Walker, MD

    Senior Fellow
    National Institutes of Health Clinical Center

    Disclosure information not submitted.

  • SW

    Sarah Warner, MPH

    Senior Epidemiologist
    National Institute of Health

    Disclosure information not submitted.

  • BS

    Bruce Swihart, PhD

    Statistician
    National Institutes of Health Clinical Center

    Disclosure information not submitted.

  • CY

    Christina Yek, MD

    Staff Clinician
    National Institutes of Health Clinical Center, Maryland

    Disclosure information not submitted.

  • SS

    Sadia Sarzynski, MD

    Staff Clinician
    National Institutes of Health Clinical Center

    Disclosure information not submitted.

  • Sameer Kadri, MD, MS

    National Institutes of Health Clinical Center

    Disclosure information not submitted.

Introduction: Invasive fungal disease (IFD) is associated with poor outcomes in the ICU. Diagnostic hurdles and competing risks of death make burden estimation and outcome attribution challenging. Recent consensus definitions for IFD minimize heterogeneity of case capture but lack either specificity to the ICU or attention to rarer species. We developed structured algorithms informed by recent broad and ICU-specific IFD consensus definitions to objectively identify IFD burden in the ICU in a large US dataset and determine risk-adjusted outcomes.


Methods: Using our novel algorithm, we identified cases of invasive mold, yeast, dimorphic species and Pneumocystis within the all-payer PINC-AI dataset. Among inpatients treated with antifungal agents, we classified proven IFD as fungal growth in sterile sites and characterized probable IFD using fungal biomarkers, molecular tests, and associated clinical features. We used marginal effects models to empirically weight cohorts and determine predicted mortality for ICU IFD cases, controlling for age, sex, Elixhauser comorbidity index, e-SOFA score, admission DNR and immune status and COVID19 co-infection.


Results: Across 239 US hospitals, 3776 (51%) of 7459 unique IFD encounters were admitted to the ICU, including 2898 proven and 878 probable cases; 33% were immunocompromised, 74% received mechanical ventilation and 75% received vasopressors. The expected adjusted mortality for the proven and probable ICU IFD cases was 39% (95% CI 37-41%) and 51% (48-54%), respectively. Adjusted mortality for proven and probable cases by organism type was 39% (37-40%) and 42% (32-53%) for yeast, 46% (33-58%) and 54% (50-57%) for molds, 42% (31-54%) and 38% (28-48%) for dimorphic organisms, and 25% (24-26%) and 44% (34-54%) for Pneumocystis. Only 20% of survivors were ultimately discharged to home.


Conclusions: Our algorithm generated a large cohort of IFD cases in adult ICU patients including a comprehensive array of organisms beyond just invasive Candida and Aspergillus captured by existing ICU-specific consensus definitions. The profound morbidity and mortality observed across all fungal organism types independent of underlying and presenting illness severity emphasizes the need to urgently improve epidemiology, diagnostics and therapeutics for critically ill patients with IFD.