Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy
Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved..
PURPOSE: COVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment.
MATERIALS AND METHODS: A retrospective, observational, multicentre study was performed from September 2020-April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria.
RESULTS: CAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy.
CONCLUSIONS: CAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:76 |
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| Enthalten in: |
Journal of critical care - 76(2023) vom: 01. Aug., Seite 154272 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
van Grootveld, Rebecca [VerfasserIn] |
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| Links: |
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| Themen: |
Aspergillus fumigatus |
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| Anmerkungen: |
Date Completed 02.06.2023 Date Revised 04.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jcrc.2023.154272 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM353080489 |
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| 100 | 1 | |a van Grootveld, Rebecca |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 02.06.2023 | ||
| 500 | |a Date Revised 04.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: COVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment | ||
| 520 | |a MATERIALS AND METHODS: A retrospective, observational, multicentre study was performed from September 2020-April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria | ||
| 520 | |a RESULTS: CAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy | ||
| 520 | |a CONCLUSIONS: CAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Aspergillus fumigatus | |
| 650 | 4 | |a CAPA | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Intensive care unit | |
| 650 | 4 | |a Invasive fungal infections | |
| 650 | 4 | |a Invasive pulmonary aspergillosis | |
| 650 | 4 | |a SARS-CoV-2 | |
| 700 | 1 | |a van der Beek, Martha T |e verfasserin |4 aut | |
| 700 | 1 | |a Janssen, Nico A F |e verfasserin |4 aut | |
| 700 | 1 | |a Ergün, Mehmet |e verfasserin |4 aut | |
| 700 | 1 | |a van Dijk, Karin |e verfasserin |4 aut | |
| 700 | 1 | |a Bethlehem, Carina |e verfasserin |4 aut | |
| 700 | 1 | |a Stads, Susanne |e verfasserin |4 aut | |
| 700 | 1 | |a van Paassen, Judith |e verfasserin |4 aut | |
| 700 | 1 | |a Heunks, Leo M A |e verfasserin |4 aut | |
| 700 | 1 | |a Bouman, Catherine S C |e verfasserin |4 aut | |
| 700 | 1 | |a Reijers, Monique H E |e verfasserin |4 aut | |
| 700 | 1 | |a Brüggeman, Roger J |e verfasserin |4 aut | |
| 700 | 1 | |a van de Veerdonk, Frank L |e verfasserin |4 aut | |
| 700 | 1 | |a van Bree, Sjoerd H W |e verfasserin |4 aut | |
| 700 | 1 | |a van den Berg, Charlotte H S B |e verfasserin |4 aut | |
| 700 | 1 | |a Kuindersma, Marnix |e verfasserin |4 aut | |
| 700 | 1 | |a Wauters, Joost |e verfasserin |4 aut | |
| 700 | 1 | |a Beishuizen, Albertus |e verfasserin |4 aut | |
| 700 | 1 | |a Verweij, Paul E |e verfasserin |4 aut | |
| 700 | 1 | |a Schouten, Jeroen A |e verfasserin |4 aut | |
| 700 | 0 | |a CAPA2.0 study group |e verfasserin |4 aut | |
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