Abstract
PurposeCorticosteroids, in particular dexamethasone, are one of the primary treatment options for critically ill COVID-19 patients. However, there are a growing number of cases that involve COVID-19-associated pulmonary aspergillosis (CAPA), and it is unclear whether dexamethasone represents a risk factor for CAPA. Our aim was to investigate a possible association of the recommended dexamethasone therapy with a risk of CAPA.MethodsWe performed a study based on a cohort of COVID-19 patients treated in 2020 in our 13 intensive care units at Charité Universitätsmedizin Berlin. We used ECMM/ISHM criteria for the CAPA diagnosis and performed univariate and multivariable analyses of clinical parameters to identify risk factors that could result in a diagnosis of CAPA.ResultsAltogether, among the n = 522 intensive care patients analyzed, n = 47 (9%) patients developed CAPA. CAPA patients had a higher simplified acute physiology score (SAPS) (64 vs. 53, p < 0.001) and higher levels of IL-6 (1,005 vs. 461, p < 0.008). They more often had severe acute respiratory distress syndrome (ARDS) (60% vs. 41%, p = 0.024), renal replacement therapy (60% vs. 41%, p = 0.024), and they were more likely to die (64% vs. 48%, p = 0.049). The multivariable analysis showed dexamethasone (OR 3.110, CI95 1.112–8.697) and SAPS (OR 1.063, CI95 1.028–1.098) to be independent risk factors for CAPA.ConclusionIn our study, dexamethasone therapy as recommended for COVID-19 was associated with a significant three times increase in the risk of CAPA.Trial registrationRegistration number DRKS00024578, Date of registration March 3rd, 2021.
Highlights
About < 5% of COVID-19 patients become critically ill [1]
Corticosteroid therapy We found that dexamethasone therapy as recommended mediated a significantly increased risk of COVID-19-associated pulmonary aspergillosis (CAPA)
We found that invasive ventilation was a relevant risk factor for CAPA which is known as important risk factors for ventilator-associated pneumonia (VAP) in general [44]
Summary
About < 5% of COVID-19 patients become critically ill [1]. International guidelines recommend corticosteroid therapy, for instance 6 mg dexamethasone systemically for 10 days, for patients in need of respiratory support [2]. As the length of the pandemic increases, a growing number of studies have reported COVID-19-associated pulmonary aspergillosis (CAPA) in these patients [3,4,5,6,7,8,9]. It is currently unclear whether the infection itself or therapeutic side-effects, e.g. those associated. It has been shown that it is predominantly patients on respiratory support who benefit from corticosteroid therapy [14]; in contrast treatment performed too early might be associated with increased mortality [21, 22]. Corticosteroid therapy is a known risk factor for influenza-associated pulmonary aspergillosis (IAPA) [23]
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