Risk factors for COVID-19 associated pulmonary aspergillosis and outcomes in patients with acute respiratory failure in a respiratory sub-intensive care unit
© 2024. The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
BMC infectious diseases - 24(2024), 1 vom: 11. Apr., Seite 392 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Iacovelli, Alessandra [VerfasserIn] |
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| Links: |
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| Themen: |
CAPA |
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| Anmerkungen: |
Date Completed 15.04.2024 Date Revised 25.04.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s12879-024-09283-3 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM370946146 |
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| 245 | 1 | 0 | |a Risk factors for COVID-19 associated pulmonary aspergillosis and outcomes in patients with acute respiratory failure in a respiratory sub-intensive care unit |
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| 520 | |a © 2024. The Author(s). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a CAPA | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Lymphocytopenia | |
| 650 | 4 | |a Respiratory failure | |
| 650 | 4 | |a Sub-intensive care unit | |
| 700 | 1 | |a Oliva, Alessandra |e verfasserin |4 aut | |
| 700 | 1 | |a Mirabelli, Flavio Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Giannone, Silvia |e verfasserin |4 aut | |
| 700 | 1 | |a Laguardia, Marianna |e verfasserin |4 aut | |
| 700 | 1 | |a Morviducci, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Nicolardi, Maria Luisa |e verfasserin |4 aut | |
| 700 | 1 | |a Repaci, Emma |e verfasserin |4 aut | |
| 700 | 1 | |a Sanzari, Maria Teresa |e verfasserin |4 aut | |
| 700 | 1 | |a Leanza, Cristiana |e verfasserin |4 aut | |
| 700 | 1 | |a Raponi, Giammarco |e verfasserin |4 aut | |
| 700 | 1 | |a Mastroianni, Claudio |e verfasserin |4 aut | |
| 700 | 1 | |a Palange, Paolo |e verfasserin |4 aut | |
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