263. COVID-19 Associated Pulmonary Aspergillosis (CAPA) at a Hospital in Nicaragua: Prevalence and Risk Factors for Mortality.

Abstract

Abstract Background COVID-19 associated pulmonary aspergillosis (CAPA) is a newly recognized clinical entity. Alterations in the mucociliary clearance, epithelial damage, lymphopenia, and the use of steroids and monoclonal antibodies could be contributing factors for the development of CAPA. The aim of this study was to detemine the prevalence of probable CAPA and risk factors for mortality in patients with COVID-19 admitted in one of the main hospitals in Nicaragua. Methods This is a retrospective cohort study of patients admitted with the diagnosis of COVID-19 in the Hospital Dr. Fernando Vélez Paiz of Managua, Nicaragua. The criteria of probable CAPA was established using the consensus of ECMM/ISHAM. Serum Aspergillus galactomannan lateral flow assay (IMMY) was determined in patients with suspect of CAPA. An optical index > 0.5 was considered positive. Different clinical and laboratory variables, and clinical outcomes were evaluated. Results A total of 325 patients were included in the study. Ninety-one patients were diagnosed with probable CAPA that means a prevalence of 28%. The mean age was 56.6 ± 15.0 years old. The most important identified comorbidities were arterial hypertension (44.2%), diabetes mellitus (29.4%), and COPD (14.8%). Lymphopenia was a remarkable finding (56% of the patients). The most frequent radiological pattern in the chest CT scan were: "crazy paving" (56.0%), ground glass opacities (28.5%), and diffuse reticulonodular infiltrates (10.9%). The mortality rate in the patients with CAPA was 42.9%. The risk factors associated with mortality in the patients with CAPA were: admission to Intensive Care Unit (ICU) (OR: 17.3; CI95%: 3.6-81.9), any chronic medical condition (OR: 9.28; CI95%: 1.13-75.90), COPD (OR: 6.41; CI95%: 1.64-24.90), use of steroids (OR: 5.03, CI95%: 1.55-16.30), lymphopenia < 1,500/mL (OR: 4.92; CI95%: 1.94-12.40), "crazy paving" pattern in CT (OR: 4.92; CI95%: 1.94-12.40), and diabetes mellitus (OR: 3.60, CI95%: 1.41-9.15). Risk factors identified for mortality in patients with COVID-19 associated pulmonary aspergillosis (CAPA). Conclusion The prevalence of probable CAPA in this study is relatively high. The mortality was of 42.9%. Risk factors for mortality were admission to ICU, chronic medical conditions (COPD and diabetes mellitus), use of steroids, lymphopenia, and radiological "crazy paving" pattern in the chest CT-scan. Disclosures All Authors: No reported disclosures.