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.
Keywords: COVID-19-associated pulmonary aspergillosis; acute respiratory distress syndrome; development; diabetes; glucocorticoids; mortality.
【저자키워드】 Glucocorticoids, acute respiratory distress syndrome, diabetes, mortality., development, COVID-19-associated pulmonary aspergillosis, 【초록키워드】 pathology, ARDS, Mortality, lymphopenia, Prevalence, Computed tomography, Cohort, Fever, Patient, large cohort, disease, consolidation, acute respiratory distress, distress, Odds ratio, Glucocorticoid treatment, immune dysregulation, lung lesion, Factor, laboratory data, Multivariable models, syndrome, multivariable analysis, high mortality, neutrophilic leukocytosis, pulse, nodule, hemoptysis, hospitalised, defined, collected, reported, the disease, analysed, homogenous, diabete, univariable, 【제목키워드】 Mortality, Cohort, intensive care patient, homogenous, New,