Comparing the clinical characteristics and outcomes of COVID-19-associate pulmonary aspergillosis (CAPA): a systematic review and meta-analysis

Abstract

Purpose Invasive pulmonary aspergillosis has been increasingly recognized in COVID-19 patients, termed COVID-19-associate pulmonary aspergillosis (CAPA). Our meta-analysis aims to assess the clinical characteristics and outcomes of patients diagnosed with CAPA compared to those without CAPA. Methods We searched the Pubmed, Cochrane Library, SCOPUS, and Web of Science databases for studies published between January 1, 2020 and August 1, 2021, containing comparative data of patients diagnosed with CAPA and those without CAPA. Results Eight cohort studies involving 729 critically ill COVID-19 patients with comparative data were included. CAPA patients were older (mean age 66.58 vs. 59.25 years; P = 0.007) and had underlying chronic obstructive pulmonary disease (COPD) (13.7 vs. 6.1%; OR 2.75; P = 0.05). No differences in gender, body mass index (BMI), and comorbidities of diabetes and cancer were observed. CAPA patients were more likely to receive long-term corticosteroid treatment (15.0 vs. 5.3%; OR 3.53; P = 0.03). CAPA patients had greater severity of illness based on sequential organ failure assessment (SOFA) score with a higher all-cause in-hospital mortality rate (42.6 vs. 26.5%; OR 3.39; P < 0.001) and earlier ICU admission from illness onset (mean 11.00 vs. 12.00 days; P = 0.003). ICU length of stay (LOS), invasive mechanical ventilation (IMV) duration, the requirement of inotropic support and renal replacement therapy were comparable between the two groups. Conclusions CAPA patients are typically older with underlying COPD and received long-term corticosteroid treatment. Furthermore, CAPA is associated with higher SOFA scores, mortality, and earlier onset of ICU admission from illness onset.

COVID‐19‐associated aspergillosis in a Brazilian referral centre: Diagnosis, risk factors and outcomes

“…Regarding the outcomes, CAPA has shown high mortality rates in different centres, usually above 40%. 18,20 We compared the mortality rates of CAPA and non-CAPA patients, and, differently from other studies, we found no statistical difference in the outcome. Our study included only COVID-19 patients that underwent bronchoscopy for the investigation of a superinfection.…”

“…Our results showed a trend towards COPD as a risk factor for CAPA. Indeed, a recent meta‐analysis has pointed out that COPD may be also a relevant risk factor for developing CAPA 20 . These findings suggest that in the context of COVID‐19 and mechanical ventilation, older and/or COPD patients with new pulmonary infiltrates that appeared despite broad‐spectrum antibiotics should be investigated for IA.…”

COVID-19 Pandemic and Periodontal Practice: The Immunological, Clinical, and Economic Points of View

“…In hospitalized COVID-19 patients, the incidences of secondary pulmonary infections were reported 16% for bacterial infections and 6.3% for fungal infections [ 76 ]. Zhou and colleagues showed that half of the patients who expired due to COVID-19 experienced a secondary infection and ventilator-associated pneumonia (VAP), occurring in one-third of patients in need of mechanical ventilation [ 77 ].…”

Disease-specific gaps within fungal respiratory tract infections: clinical features, diagnosis, and management in critically ill patients

“…In a recent meta-analysis including (eight cohort studies, 729 critically ill COVID-19 patients with comparative), reported the following outcome measures: CAPA patients were older, these patients had underlying COPD, and were more likely to receive long-term corticosteroid treatment. CAPA patients had a greater Sequential Organ Failure Assessment score with a higher all-cause in-hospital mortality rate (42.6 vs. 26.5%; odds ratio 3.39; P < 0.001) [23 ▪▪ ]. ICU setting-related factors, such as environmental factors, isolation conditions, ventilation systems, building renovation works, and temporal spread with respect to pandemic waves, should be considered for evaluation of CAPA risk [24].…”