Journal Article

Risk factors for COVID-19 associated pulmonary aspergillosis and outcomes in patients with acute respiratory failure in a respiratory sub-intensive care unit

Raponi, Giammarco, Sanzari, Maria Teresa, Morviducci, Matteo, Iacovelli, Alessandra, Nicolardi, Maria Luisa, Leanza, Cristiana, Oliva, Alessandra, Mirabelli, Flavio Marco, Mastroianni, Claudio, Repaci, Emma, Palange, Paolo, Giannone, Silvia, Laguardia, Marianna

2024

Overview

Background COVID-19-associated pulmonary aspergillosis (CAPA) is burdened by high mortality. Data are lacking about non-ICU patients. Aims of this study were to: (i) assess the incidence and prevalence of CAPA in a respiratory sub-intensive care unit, (ii) evaluate its risk factors and (iii) impact on in-hospital mortality. Secondary aims were to: (i) assess factors associated to mortality, and (ii) evaluate significant features in hematological patients. Materials and methods This was a single-center, retrospective study of COVID-19 patients with acute respiratory failure. A cohort of CAPA patients was compared to a non-CAPA cohort. Among patients with CAPA, a cohort of hematological patients was further compared to another of non-hematological patients. Results Three hundred fifty patients were included in the study. Median P/F ratio at the admission to sub-intensive unit was 225 mmHg (IQR 155–314). 55 (15.7%) developed CAPA (incidence of 5.5%). Eighteen had probable CAPA (37.3%), 37 (67.3%) possible CAPA and none proven CAPA. Diagnosis of CAPA occurred at a median of 17 days (IQR 12–31) from SARS-CoV-2 infection. Independent risk factors for CAPA were hematological malignancy [OR 1.74 (95%CI 0.75–4.37), p  = 0.0003], lymphocytopenia [OR 2.29 (95%CI 1.12–4.86), p  = 0.02], and COPD [OR 2.74 (95%CI 1.19–5.08), p  = 0.014]. Mortality rate was higher in CAPA cohort (61.8% vs 22.7%, p  < 0.0001). CAPA resulted an independent risk factor for in-hospital mortality [OR 2.92 (95%CI 1.47–5.89), p  = 0.0024]. Among CAPA patients, age > 65 years resulted a predictor of mortality [OR 5.09 (95% CI 1.20–26.92), p  = 0.035]. No differences were observed in hematological cohort. Conclusion CAPA is a life-threatening condition with high mortality rates. It should be promptly suspected, especially in case of hematological malignancy, COPD and lymphocytopenia.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute respiratory distress syndrome / Anesthesia / Antibiotics / Aspergillosis / CAPA / Care and treatment / Chronic obstructive pulmonary disease / Comorbidity / Comparative analysis / Complications and side effects / Continuous positive airway pressure / COVID-19 / Critically ill / Development and progression / Dexmedetomidine / Disease / Hematology / Hospital patients / Hospitals / Immune system / Infections / Infectious Diseases / Intensive care / Internal Medicine / Lung diseases, Obstructive / Lymphocytes / Lymphocytopenia / Lymphopenia / Malignancy / Medical imaging / Medical Microbiology / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Mortality / Ostomy / Parasitology / Patient outcomes / Pneumonia / Pulmonary aspergillosis / Respiratory failure / Respiratory insufficiency / Risk factors / Severe acute respiratory syndrome coronavirus 2 / Statistical analysis / Sub-intensive care unit / Tropical Medicine / Ventilators