Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, 12208, USA.
Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, MO, 65775, USA.
Infection. 2022 Feb;50(1):43-56. doi: 10.1007/s15010-021-01701-x. Epub 2021 Sep 27.
Invasive pulmonary aspergillosis has been increasingly recognized in COVID-19 patients, termed COVID-19-associate pulmonary aspergillosis (CAPA). Our meta-analysis aims to assess the clinical characteristics and outcomes of patients diagnosed with CAPA compared to those without CAPA.
We searched the Pubmed, Cochrane Library, SCOPUS, and Web of Science databases for studies published between January 1, 2020 and August 1, 2021, containing comparative data of patients diagnosed with CAPA and those without CAPA.
Eight cohort studies involving 729 critically ill COVID-19 patients with comparative data were included. CAPA patients were older (mean age 66.58 vs. 59.25 years; P = 0.007) and had underlying chronic obstructive pulmonary disease (COPD) (13.7 vs. 6.1%; OR 2.75; P = 0.05). No differences in gender, body mass index (BMI), and comorbidities of diabetes and cancer were observed. CAPA patients were more likely to receive long-term corticosteroid treatment (15.0 vs. 5.3%; OR 3.53; P = 0.03). CAPA patients had greater severity of illness based on sequential organ failure assessment (SOFA) score with a higher all-cause in-hospital mortality rate (42.6 vs. 26.5%; OR 3.39; P < 0.001) and earlier ICU admission from illness onset (mean 11.00 vs. 12.00 days; P = 0.003). ICU length of stay (LOS), invasive mechanical ventilation (IMV) duration, the requirement of inotropic support and renal replacement therapy were comparable between the two groups.
CAPA patients are typically older with underlying COPD and received long-term corticosteroid treatment. Furthermore, CAPA is associated with higher SOFA scores, mortality, and earlier onset of ICU admission from illness onset.
COVID-19 患者中侵袭性肺曲霉病的发病率逐渐增高，被称为 COVID-19 相关肺曲霉病（CAPA）。本荟萃分析旨在评估与未发生 CAPA 的患者相比，诊断为 CAPA 的患者的临床特征和结局。
我们检索了 Pubmed、Cochrane 图书馆、SCOPUS 和 Web of Science 数据库，纳入了 2020 年 1 月 1 日至 2021 年 8 月 1 日期间发表的包含 CAPA 患者与未发生 CAPA 的患者比较数据的研究。
共纳入 8 项包含 729 例危重症 COVID-19 患者的对照数据的队列研究。CAPA 患者年龄更大（平均年龄 66.58 岁 vs. 59.25 岁；P=0.007），且更常患有慢性阻塞性肺疾病（COPD）（13.7% vs. 6.1%；OR 2.75；P=0.05）。两组患者的性别、体重指数（BMI）以及糖尿病和癌症等合并症无差异。CAPA 患者更可能接受长期皮质类固醇治疗（15.0% vs. 5.3%；OR 3.53；P=0.03）。基于序贯器官衰竭评估（SOFA）评分，CAPA 患者的疾病严重程度更高，全因院内死亡率更高（42.6% vs. 26.5%；OR 3.39；P<0.001），从发病到入住 ICU 的时间更早（平均 11.00 天 vs. 12.00 天；P=0.003）。两组患者的 ICU 住院时间（LOS）、有创机械通气（IMV）持续时间、正性肌力支持和肾脏替代治疗的需求无差异。
CAPA 患者通常年龄较大，患有 COPD，且接受长期皮质类固醇治疗。此外，与未发生 CAPA 的患者相比，CAPA 与更高的 SOFA 评分、死亡率和更早从发病到入住 ICU 的时间相关。
