Diabetes Increases Risk of Invasive Aspergillosis in ICU Patients: Study

A systematic review and meta-analysis revealed a significant association between diabetes mellitus (DM) and invasive aspergillosis (IA) among critically ill patients in intensive care units (ICUs). The findings published in the BMC Infectious Diseases suggest that diabetic patients in ICUs face a higher risk of developing this life-threatening fungal infection.

This comprehensive analysis of 20 studies involved a  total of 6,155 ICU patients. Published in medical databases like PubMed, EMBASE, and the Cochrane Library, this review found that DM increases the risk of IA development by 18% (odds ratio [OR] = 1.18; 95% confidence interval [CI]: 1.01 to 1.39; p = 0.04).

The study highlighted the stability of the association between DM and IA, as confirmed by sensitivity analysis. Heterogeneity among the included studies was low, with I² at 5%, which indicated consistency in the results. Moreover, there was no significant publication bias (Egger’s test p = 0.654; Begg’s test p = 0.417).

This research revealed that diabetic patients had a 40% higher risk of developing COVID-19-associated pulmonary aspergillosis (CAPA) when compared to non-diabetic ICU patients (OR = 1.40; 95% CI: 1.15 to 1.70; p < 0.001). The findings highlight a critical concern during the ongoing pandemic, where CAPA has been associated with increased morbidity and mortality in ICU settings.

The relationship between DM and IA was not significant in ICU patients with influenza (OR = 0.81; 95% CI: 0.54 to 1.23; p = 0.32). The heterogeneity in this subgroup was minimal (I² = 8%; p = 0.36), suggesting that the association may be more virus-specific. The findings carry important clinical implications. As IA continues to pose a serious threat to ICU patients, clinicians must remain cautious when treating diabetic patients or those with comorbidities like COVID-19.

Overall, this research illuminates the need for proactive diagnostic strategies and early antifungal interventions to reduce the risks associated with IA. Given the increased vulnerability of diabetic patients in the ICU, a customized approach to infection management is essential. This meta-analysis provides strong evidence linking DM to IA in critically ill patients and highlights the significant risk posed by COVID-19 in this context.

Reference:

Liu, Y., Zhang, Z., Zhou, L., Lin, T., Zhang, R., Li, M., Chen, S., Liu, X., & Liu, X. (2025). Invasive aspergillosis in critically ill patients with diabetes mellitus: a systematic review and meta-analysis. BMC Infectious Diseases, 25(1). https://doi.org/10.1186/s12879-025-10560-y