Abstract
Our study aims to assess the prevalence of CAPA (COVID-19-associated pulmonary aspergillosis) and describe the associated risk factors and their impact on mortality. A prospective study was conducted. We included patients with COVID-19 disease who were admitted to the ICU with a diagnosis of respiratory failur. Mycological culture and other biomarkers (calcofluor staining, LFD, LFA, PCR, GM, and B-D-glucan) were performed. A total of 300 patients were included in the study. Thirty-five patients were diagnosed with CAPA (prevalence 11.7%). During admission, 57 patients died (19%), and, in the group of CAPA patients, mortality was 31.4%. In multivariate analysis, independent risk factors associated with CAPA diagnosis were age (OR: 1.05; 95% CI 1.01–1.09; p = 0.037), chronic lung disease (OR: 3.85; 95% CI 1.02–14.9; p = 0.049) and treatment with tocilizumab during admission (OR: 14.5; 95% 6.1–34.9; p = 0.001). Factors independently associated with mortality were age (OR: 1.06; 95% CI 1.01–1.11; p = 0.014) and CAPA diagnosis during admission (OR: 3.34; 95% CI 1.38–8.08; p = 0.007). CAPA is an infection that appears in many patients with COVID-19 disease. CAPA is associated with high mortality rates, which may be reduced by early diagnosis and initiation of appropriate antifungal therapy, so screening of COVID-19 ARDS (acute respiratory distress syndrome) patients for CAPA is essential.
Highlights
The association between influenza virus infection and invasive pulmonary aspergillosis (IPA) has been described in the last decade in patients admitted to intensive care units, with mortality reported as high as 50% in some studies [1,2,3]
Factors independently associated with mortality were age (OR: 1.06; 95% CI 1.01–1.11; p = 0.014) and COVID-19-associated pulmonary aspergillosis (CAPA) diagnosis during admission (OR: 3.34; 95% CI 1.38–8.08; p = 0.007)
In the analysis of factors associated with CAPA diagnosis, we describe that these patients were older, had chronic lung disease more frequently, and received treatment with tocilizumab in a higher proportion than those who did not present CAPA
Summary
The association between influenza virus infection and invasive pulmonary aspergillosis (IPA) has been described in the last decade in patients admitted to intensive care units, with mortality reported as high as 50% in some studies [1,2,3]. The outbreak of the SARSCOV-2 infection has caused a progressive increase in the number of cases of IPA associated with COVID-19 disease (CAPA), with significant mortality rates [4]. Patients usually present severe radiological lesions other than those characteristics of fungal infection. For these reasons, the commonly used IPA diagnostic criteria (EORTC/MSGERC) [5] are not helpful when assessing IPA in these patients
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