New insights into development and mortality of COVID‐19‐associated pulmonary aspergillosis in a homogenous cohort of 1161 intensive care patients

Abstract

Background COVID‐19‐associated pulmonary aspergillosis (CAPA) has been widely reported but homogenous large cohort studies are needed to gain real‐world insights about the disease. Methods We collected clinical and laboratory data of 1161 patients hospitalised at our Institute from March 2020 to August 2021, defined their CAPA pathology, and analysed the data of CAPA/non‐CAPA and deceased/survived CAPA patients using univariable and multivariable models. Results The overall prevalence and mortality of CAPA in our homogenous cohort of 1161 patients were 6.4% and 47.3%, respectively. The mortality of CAPA was higher than that of non‐CAPA patients (hazard ratio: 1.8 [95% confidence interval: 1.1–2.8]). Diabetes (odds ratio [OR] 1.92 [1.15–3.21]); persistent fever (2.54 [1.17–5.53]); hemoptysis (7.91 [4.45–14.06]); and lung lesions of cavitation (8.78 [2.27–34.03]), consolidation (9.06 [2.03–40.39]), and nodules (8.26 [2.39–28.58]) were associated with development of CAPA by multivariable analysis. Acute respiratory distress syndrome (ARDS) (2.68 [1.09–6.55]), a high computed tomography score index (OR 1.18 [1.08–1.29]; p < .001), and pulse glucocorticoid treatment (HR 4.0 [1.3–9.2]) were associated with mortality of the disease. Whereas neutrophilic leukocytosis (development: 1.09 [1.03–1.15] and mortality: 1.17 [1.08–1.28]) and lymphopenia (development: 0.68 [0.51–0.91] and mortality: 0.40 [0.20–0.83]) were associated with the development as well as mortality of CAPA. Conclusion We observed a low but likely underestimated prevalence of CAPA in our study. CAPA is a disease with high mortality and diabetes is a significant factor for its development while ARDS and pulse glucocorticoid treatment are significant factors for its mortality. Cellular immune dysregulation may have a central role in CAPA from its development to mortality.

Gut microbial disruption in critically ill patients with COVID-19 associated pulmonary aspergillosis

“…Coinfection, on the other hand, leads to a significant worsening of respiratory symptoms with increased mortality in patients with viral pulmonary infections (20). This also applies to SARS-CoV-2 infection, in which coinfection with Aspergillus fumigatus , can lead to COVID-19-associated pulmonary aspergillosis with poor outcome and the need for intensive care (5, 7). Risk factors of CAPA disease include severe lung injury in the setting of COVID-19, older age, and preexisting pulmonary disease (21).…”

“…Similar to severe influenza pneumonia, this new viral disease can also lead to the emergence of invasive pulmonary aspergillosis in patients admitted to the ICU (4,5).…”

“…The so called COVID-19-associated pulmonary aspergillosis (CAPA) is an opportunistic secondary infection, primarily affecting ICU patients with severe acute respiratory distress syndrome (ARDS) (5). Patients affected by COVID-19 associated ARDS and CAPA suffer from an increased morbidity and mortality compared to patients without CAPA and COVID-19 ARDS (6,7).…”

“…Similar to severe influenza pneumonia, this new viral disease can also lead to the emergence of invasive pulmonary aspergillosis in patients admitted to the ICU (4, 5). The so called COVID-19-associated pulmonary aspergillosis (CAPA) is an opportunistic secondary infection, primarily affecting ICU patients with severe acute respiratory distress syndrome (ARDS) (5). Patients affected by COVID-19 associated ARDS and CAPA suffer from an increased morbidity and mortality compared to patients without CAPA and COVID-19 ARDS (6, 7).…”

Aspergillosis and COVID-19 in an intensive care unit in Brazil: a series of cases

“…COVID-19-Associated Pulmonary Aspergillosis (CAPA) is one of the main complications of severely ill patients with COVID-19 (Calderón-Parra et al, 2022;Hashim et al, 2022), occurring in approximately 10% of patients admitted to the Intensive Care Unit (ICU) worldwide (Calderón-Parra et al, 2022;Hashim et al, 2022) and higher mortality rate compared with patients without CAPA (Bartoletti, 2020;Calderón-Parra et al, 2022;Chong et al, 2022). Recent reports from Netherlands, Brazil and Spain report invasive aspergillosis in 19%, 16% and 11% patients with severe COVID-19 pneumonia, respectively (Koehler et al, 2020;de Almeida Jr et al, 2022;Marta et al, 2022).…”