Abstract
Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), which impacts their chances of survival. Whether positive bronchoalveolar lavage fluid (BALF) mycological tests can be used as a survival proxy remains unknown. We conducted a post hoc analysis of a previous multicenter, multinational observational study with the aim of assessing the differential prognostic impact of BALF mycological tests, namely, positive (optical density index of ≥1.0) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination for critically ill patients with COVID-19. Of the 592 critically ill patients with COVID-19 enrolled in the main study, 218 were included in this post hoc analysis, as they had both test results available. CAPA was diagnosed in 56/218 patients (26%). Most cases were probable CAPA (51/56 [91%]) and fewer were proven CAPA (5/56 [9%]). In the final multivariable model adjusted for between-center heterogeneity, an independent association with 90-day mortality was observed for the combination of positive BALF GM and positive BALF Aspergillus culture in comparison with both tests negative (hazard ratio, 2.53; 95% CI confidence interval [CI], 1.28 to 5.02; P = 0.008). The other independent predictors of 90-day mortality were increasing age and active malignant disease. In conclusion, the combination of positive BALF GM and positive BALF Aspergillus culture was associated with increased 90-day mortality in critically ill patients with COVID-19. Additional study is needed to explore the possible prognostic value of other BALF markers.
Keywords: Aspergillus; BALF; CAPA; COVID-19; GM; biomarker; galactomannan.
【저자키워드】 COVID-19, Biomarker, Aspergillus, BALF, CAPA, GM, galactomannan., 【초록키워드】 coronavirus disease, Mortality, heterogeneity, survival, Bronchoalveolar lavage fluid, Culture, Impact, Patient, optical, multicenter, prognostic, association, Combination, Analysis, Critically ill patient, confidence interval, Prognostic value, 95% CI, hazard ratio, increasing age, positive, malignant disease, MOST, independent, final multivariable model, enrolled, develop, diagnosed, conducted, can be used, adjusted, independent predictor, with COVID-19, 【제목키워드】 intensive care unit, pulmonary, Impact, aspergillosis, mycology, galactomannan, European, lavage, Result,