Epidemiology, Risk Factors, and Routine Blood Biomarkers of Aspergillosis in Cancer Patients in Jiangxi, China

Hazrat Bilal,1 Xunsong Wang,2 Jiamei Yu,1 Yan Li,1 Xiaohui Li,1 Hanman Qiu,1 Muhammad Nadeem Khan,3 Rahat Ullah Khan,4,5 Muhammad Shafiq,6 Qiao-Li Lv,1 Bin Xu1 1Jiangxi Key Laboratory of Oncology (2024SSY06041), JXHC Key Laboratory of Tumour Metastasis, Jiangxi Cancer Hospital & Institute, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330029, People’s Republic of China; 2Department of Medical Laboratory, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Cancer Institute, Nanchang, Jiangxi, 330029, People’s Republic of China; 3Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of China; 4College of Life Sciences, University of Chinese Academy of Sciences, Beijing, 101408, People’s Republic of China; 5CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Center for Influenza Research and Early-Warning (CASCIRE), CAS-TWAS Center of Excellence for Emerging Infectious Diseases (CEEID), Chinese Academy of Sciences (CAS), Beijing, 100101, People’s Republic of China; 6Research Institute of Clinical Pharmacy, Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of ChinaCorrespondence: Qiao-Li Lv, Jiangxi Key Laboratory of Oncology (2024SSY06041), JXHC Key Laboratory of Tumour Metastasis, Jiangxi Cancer Hospital & Institute, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330029, People’s Republic of China, Email lvqiaoli2008@126.com Bin Xu, Jiangxi Key Laboratory of Oncology (2024SSY06041), JXHC Key Laboratory of Tumour Metastasis, Jiangxi Cancer Hospital & Institute, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330029, People’s Republic of China, Email xubin1968@126.comObjective: Aspergillosis is a serious public health concern worldwide; however, its epidemiology and clinical predictors remain poorly characterized among cancer patients in China, particularly in regions such as Jiangxi, where regional data are limited. This study aimed to evaluate the epidemiology, risk factors, and potential utility of routine inflammatory biomarkers in distinguishing Aspergillus colonization from infection in this population.Methods: In the current retrospective study, the epidemiology, risk factors, and blood biomarkers of Aspergillus cases among cancer patients at Jiangxi Cancer Hospital in Nanchang, China, were investigated from 2021 to 2025.Results: There were 354 cases in all, with 14.1% colonization, 43.5% possible infections, and 42.4% probable infections. Almost half of the patients had underlying lung cancer (n = 161, 45.48%), and Aspergillus fumigatus (n = 313, 88.42%) was the most frequently detected species. The use of steroids (OR 18.16, p < 0.001), chemotherapy (OR 5.41, p = 0.003), and high glucose levels (OR 1.68, p = 0.02) were shown to be independent risk factors for infection in all cancer populations. In lung cancer patients, smoking (OR 4.11, p < 0.001), chronic obstructive pulmonary disease (COPD) (OR 3.83, p = 0.02), and steroid usage (OR 3.06, p = 0.03) were independently related to higher infection risk. Biomarker analysis revealed that probable infection was associated with higher neutrophil and white blood cell (WBC) counts, a higher neutrophil-to-lymphocyte ratio (NLR), and metabolic markers, including glucose and creatinine. Principal component analysis (PCA) demonstrated distinct clustering driven by inflammatory signatures.Conclusion: This study provides comprehensive epidemiological data on aspergillosis in a large cohort of cancer patients in Jiangxi, China, and highlights the potential value of routinely available inflammatory markers in differentiating colonization from infection. These findings may support early risk stratification and improve clinical decision-making, particularly in resource-limited settings where advanced fungal diagnostics are not readily available.Keywords: invasive aspergillosis, colonization, cancer patients, risk factors, inflammatory biomarkers