Eligibility Criteria:
Inclusion Criteria
Patients must meet all of the following criteria to be eligible for enrollment:
1. Willing to participate in the study and able to provide written informed consent;
2. Hospitalized patients admitted to the intensive care unit (ICU);
3. Age ≥ 18 years, with no restriction on sex;
4. Proven or probable invasive aspergillosis (IA), defined as follows:
Proven IA
Proven IA is diagnosed if at least one of the following criteria is met:
1. Histopathological or cytopathological evidence of invasive Aspergillus spp. hyphae in tissue specimens obtained from a sterile site or the lung (e.g., biopsy or needle aspiration), with confirmation by culture or polymerase chain reaction (PCR);
2. Isolation of Aspergillus spp. by culture from a specimen obtained from a sterile site (e.g., biopsy or needle aspiration), with the lesion consistent with an infectious process.
Probable IA
Probable IA requires the presence of all of the following criteria:
1. At least one host factor (e.g., COVID-19, influenza, solid malignancy, HIV infection with CD4 \<200 cells/µL, decompensated liver cirrhosis, or moderate to severe chronic obstructive pulmonary disease \[COPD\]);
2. At least one compatible clinical feature (e.g., fever ≥38.3 °C lasting ≥3 days, pleuritic chest pain, dyspnea, hemoptysis, or worsening respiratory failure despite appropriate antibacterial therapy);
3. At least one compatible radiological finding (e.g., newly developed pulmonary infiltrates on chest computed tomography, or cavitary lesions not explained by other causes);
4. At least one mycological criterion (e.g., positive culture for Aspergillus spp. from bronchoalveolar lavage fluid \[BALF\], serum galactomannan \>0.5 optical density index \[ODI\], or BALF galactomannan ≥1.0 ODI).
5. Concomitant hepatic dysfunction meeting at least one of the following conditions:
* Aminotransferase levels \>3 times the upper limit of normal (ULN) and \<10 times ULN;
* Child-Pugh class A or B;
6. Expected to receive antifungal therapy for ≥5 days.
Exclusion Criteria
Patients meeting any of the following criteria will be excluded:
1. Pregnant or breastfeeding women;
2. Known allergy or hypersensitivity to amphotericin B or any of its formulations;
3. Previous treatment with extracorporeal membrane oxygenation (ECMO);
4. Expected life expectancy \<48 hours;
5. Patients who, at the time of enrollment, are confirmed to require antifungal agents other than those specified in the study protocol;
6. Presence of any of the following severe comorbid conditions that may interfere with assessment of study efficacy or safety:
* Acute liver failure or acute decompensation of chronic liver failure;
* Known or suspected active pulmonary tuberculosis, cystic fibrosis, lung abscess, empyema, or obstructive pneumonia;
7. Severe renal impairment, defined as any of the following:
* Creatinine clearance (CrCL) \<16 mL/min at enrollment;
* Requirement for hemodialysis, peritoneal dialysis, or other renal replacement therapy at enrollment;
8. Participation in another clinical trial within 3 months prior to enrollment;
9. Previous enrollment in this study;
10. Any condition that may affect study compliance or outcome assessment (e.g., planned major surgery, or inability to comply with the study protocol due to disease severity or poor adherence);
11. Any other condition deemed by the investigator to make the patient unsuitable for participation.