Risk factors and clinical impact of COVID-19-associated pulmonary aspergillosis: Multicenter retrospective cohort study

Abstract

Background/Aims: The risk factors and clinical impacts of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) remain controversial, and no data have been reported in Korea. This study aimed to investigate the epidemiology and importance of CAPA diagnostic efforts and to identify the predictors of CAPA and the impacts on clinical outcomes.Methods: Between January 2020 and May 2021, data of severely to critically ill COVID-19 patients were extracted from seven hospitals of the Catholic Medical Center through a clinical data warehouse. Corticosteroid use was subcategorized into total cumulative dose, early 7-day dose, mean daily dose, and duration of use.Results: A total of 2,427 patients were screened, and 218 patients were included. CAPA was diagnosed in 4.6% (10/218) of all hospitalized and 11.2% (10/89) of intensive care unit patients. Total cumulative dose (over 1,000 mg as methylprednisolone) and daily high-dose corticosteroid use (over 60 mg/day) were independent predictors but not early 7-day high-dose corticosteroid use (over 420 mg/week) (odds ratio [OR], 1.731; 95% confidence interval [CI], 0.350 to 8.571) nor prolonged use (OR, 2.794; 95% CI, 0.635 to 13.928). In-hospital overall mortality was 11.9% (26 of 218). CAPA itself did not affect the outcome; rather, daily high-dose steroid use significantly increased the 30-day mortality (hazard ratio, 5.645; 95% CI, 1.225 to 26.091).Conclusions: CAPA was not uncommon, especially in critically ill patients. Daily high-dose corticosteroid use was the predictor of CAPA and associated with high mortality rates. High-dose corticosteroids use after early inflammatory phase should be avoided, and active surveillance methods for CAPA are essential for those high-risk patients.

Call for evidence mapping in accordance with the changing features of invasive pulmonary aspergillosis during the coronavirus disease 2019 pandemic

“…I had the opportunity to contribute to an editorial on a recent article regarding the incidence of invasive pulmonary aspergillosis in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19) [ 1 ]. While many studies are focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection itself, it is important to note that COVID-19 has led to various prognostic changes in many other common diseases.…”

“…Recently, Lee et al [ 1 ] reported that the incidence of CAPA in the Republic of Korea (ROK) was 11.2% among ICU patients with COVID-19. These data are comparable with findings from a multicenter retrospective study in the ROK [ 5 ].…”

“…Notably, periodic screening is important for improving diagnostic sensitivity in clinical settings when host factors mentioned in the EORTC/MSGERC definition are present or the local incidence of CAPA is high. Lee et al [ 1 ] observed that the overall mortality associated with CAPA was 50.0% in ICU patients. This is similar to the findings of a previous study that included patients from the ROK [ 5 ].…”

“…Additionally, particular attention is needed concerning the clinical impact of corticosteroids or immune modulators on the incidence and mortality of CAPA. Lee et al [ 1 ] demonstrated that daily high-dose steroid use (methylprednisolone > 60 mg/day) was an independent predictor of CAPA that led to a significant increase in the 30-day mortality rate. This finding is consistent with the results of previous studies [ 5 , 8 ].…”

“…Lee et al [ 1 ] reported that the median time to diagnosis after admission was 9.5 days (interquartile range, 7.0 to 12.0). In a previous study, the median interval between admission to the ICU and diagnosis of CAPA was 9 days (interquartile range, 5 to 13).…”