2019冠状病毒病重症监护病房患者侵袭性曲霉病的危险因素：一项多中心回顾性研究
Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study.
作者信息
Xu Jiqian, Yang Xiaobo, Lv Zheng, Zhou Ting, Liu Hong, Zou Xiaojing, Cao Fengsheng, Zhang Lu, Liu Boyi, Chen Wei, Yu Yuan, Shu Huaqing, Yuan Shiying, Hu Ming, Huang Chaolin, Shang You
机构信息
Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Research Center for Translational Medicine, Jinyintan Hospital, Wuhan, China.
出版信息
Front Med (Lausanne). 2021 Nov 16;8:753659. doi: 10.3389/fmed.2021.753659. eCollection 2021.
Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs), but risk factors for COVID-19-associated IPA (CAPA) have not been fully characterized. The aim of the current study was to identify factors associated with CAPA, and assess long-term mortality. A retrospective cohort study of adult COVID-19 patients admitted to ICUs from six hospitals was conducted in Hubei, China. CAPA was diagnosed via composite clinical criteria. Demographic information, clinical variables, and 180-day outcomes after the diagnosis of CAPA were analyzed. Of 335 critically ill patients with COVID-19, 78 (23.3%) developed CAPA within a median of 20.5 days (range 13.0-42.0 days) after symptom onset. Compared to those without CAPA, CAPA patients were more likely to have thrombocytopenia (50 vs. 19.5%, < 0.001) and secondary bacterial infection prior to being diagnosed with CAPA (15.4 vs. 6.2%, = 0.013), and to receive vasopressors (37.2 vs. 8.6%, < 0.001), higher steroid dosages (53.9 vs. 34.2%, = 0.002), renal replacement therapy (37.2 vs. 13.6%, < 0.001), and invasive mechanical ventilation (57.7 vs. 35.8%, < 0.001). In multivariate analysis incorporating hazard ratios (HRs) and confidence intervals (CIs), thrombocytopenia (HR 1.98, 95% CI 1.16-3.37, = 0.012), vasopressor use (HR 3.57, 95% CI 1.80-7.06, < 0.001), and methylprednisolone use at a daily dose ≥ 40 mg (HR 1.69, 95% CI 1.02-2.79, = 1.02-2.79) before CAPA diagnosis were independently associated with CAPA. Patients with CAPA had longer median ICU stays (17 days vs. 12 days, = 0.007), and higher 180-day mortality (65.4 vs. 33.5%, < 0.001) than those without CAPA. Thrombocytopenia, vasopressor use, and corticosteroid treatment were significantly associated with increased risk of incident IPA in COVID-19 patients admitted to ICUs. The occurrence of CAPA may increase the likelihood of long-term COVID-19 mortality.
侵袭性肺曲霉病（IPA）是入住重症监护病房（ICU）的2019冠状病毒病（COVID-19）患者的一种危及生命的并发症，但COVID-19相关IPA（CAPA）的危险因素尚未完全明确。本研究的目的是确定与CAPA相关的因素，并评估长期死亡率。在中国湖北，对来自六家医院入住ICU的成年COVID-19患者进行了一项回顾性队列研究。CAPA通过综合临床标准进行诊断。分析了人口统计学信息、临床变量以及CAPA诊断后180天的结局。在335例COVID-19重症患者中，78例（23.3%）在症状出现后的中位20.5天（范围13.0 - 42.0天）内发生了CAPA。与未发生CAPA的患者相比，CAPA患者在被诊断为CAPA之前更有可能出现血小板减少（50%对19.5%，<0.001）和继发性细菌感染（15.4%对6.2%，=0.013），并且更有可能接受血管加压药治疗（37.2%对8.6%，<0.001）、使用更高剂量的类固醇（53.9%对34.2%，=0.002）、接受肾脏替代治疗（37.2%对13.6%，<0.001）以及有创机械通气（57.7%对35.8%，<0.001）。在纳入风险比（HRs）和置信区间（CIs）的多变量分析中，血小板减少（HR 1.98，95%CI 1.16 - 3.37，=0.012）、使用血管加压药（HR 3.57，95%CI 1.80 - 7.06，<0.001）以及在CAPA诊断前每日使用甲基泼尼松龙剂量≥40mg（HR 1.69，95%CI 1.02 - 2.79，=1.02 - 2.79）与CAPA独立相关。与未发生CAPA的患者相比，发生CAPA的患者在ICU的中位住院时间更长（17天对12天，=0.007），180天死亡率更高（65.4%对33.5%，<0.001）。血小板减少、使用血管加压药和皮质类固醇治疗与入住ICU的COVID-19患者发生IPA的风险增加显著相关。CAPA的发生可能会增加COVID-19长期死亡率的可能性。
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