Purpose Corticosteroids, in particular dexamethasone, are one of the primary treatment options for critically ill COVID-19 patients. However, there are a growing number of cases that involve COVID-19-associated pulmonary aspergillosis (CAPA), and it is unclear whether dexamethasone represents a risk factor for CAPA. Our aim was to investigate a possible association of the recommended dexamethasone therapy with a risk of CAPA. Methods We performed a study based on a cohort of COVID-19 patients treated in 2020 in our 13 intensive care units at Charité Universitätsmedizin Berlin. We used ECMM/ISHM criteria for the CAPA diagnosis and performed univariate and multivariable analyses of clinical parameters to identify risk factors that could result in a diagnosis of CAPA. Results Altogether, among the n = 522 intensive care patients analyzed, n = 47 (9%) patients developed CAPA. CAPA patients had a higher simplified acute physiology score (SAPS) (64 vs. 53, p < 0.001) and higher levels of IL-6 (1,005 vs. 461, p < 0.008). They more often had severe acute respiratory distress syndrome (ARDS) (60% vs. 41%, p = 0.024), renal replacement therapy (60% vs. 41%, p = 0.024), and they were more likely to die (64% vs. 48%, p = 0.049). The multivariable analysis showed dexamethasone (OR 3.110, CI95 1.112–8.697) and SAPS (OR 1.063, CI95 1.028–1.098) to be independent risk factors for CAPA. Conclusion In our study, dexamethasone therapy as recommended for COVID-19 was associated with a significant three times increase in the risk of CAPA. Trial registration Registration number DRKS00024578, Date of registration March 3rd, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03902-8.
【저자키워드】 Corticosteroid, COVID-19, Dexamethasone, CAPA, pulmonary aspergillosis, 【초록키워드】 Treatment, ARDS, therapy, IL-6, intensive care unit, Diagnosis, risk, risk factor, Cohort, Critically ill, Patient, Berlin, COVID-19 patients, association, acute respiratory distress, renal replacement therapy, COVID-19 patient, criteria, registration number, supplementary material, syndrome, multivariable analysis, Charité, independent risk factor, clinical parameter, intensive care patient, Result, analyzed, identify, performed, treated, increase in, Date, 【제목키워드】 risk factor, intensive care patient,