Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), Majadahonda, Spain.
Mycoses. 2022 May;65(5):541-550. doi: 10.1111/myc.13434. Epub 2022 Mar 15.
COVID-19-associated pulmonary aspergillosis (CAPA) is a major complication of critically ill COVID-19 patients, with a high mortality rate and potentially preventable. Thus, identifying patients at high risk of CAPA would be of great interest. We intended to develop a clinical prediction score capable of stratifying patients according to the risk for CAPA at ICU admission.
Single centre retrospective case-control study. A case was defined as a patient diagnosed with CAPA according to 2020 ECMM/ISHAM consensus criteria. 2 controls were selected for each case among critically ill COVID-19 patients.
28 CAPA patients and 56-matched controls were included. Factors associated with CAPA included old age (68 years vs. 62, p = .033), active smoking (17.9% vs. 1.8%, p = .014), chronic respiratory diseases (48.1% vs. 26.3%, p = .043), chronic renal failure (25.0% vs. 3.6%, p = .005), chronic corticosteroid treatment (28.6% vs. 1.8%, p < .001), tocilizumab therapy (92.9% vs. 66.1%, p = .008) and high APACHE II at ICU admission (median 13 vs. 10 points, p = .026). A score was created including these variables, which showed an area under the receiver operator curve of 0.854 (95% CI 0.77-0.92). A punctuation below 6 had a negative predictive value of 99.6%. A punctuation of 10 or higher had a positive predictive value of 27.9%.
We present a clinical prediction score that allowed to stratify critically ill COVID-19 patients according to the risk for developing CAPA. This CAPA score would allow to target preventive measures. Further evaluation of the score, as well as the utility of these targeted preventive measures, is needed.
COVID-19 相关肺曲霉病（CAPA）是危重症 COVID-19 患者的主要并发症，死亡率高且具有潜在可预防性。因此，识别 CAPA 高危患者将具有重要意义。我们旨在开发一种临床预测评分，能够根据 ICU 入院时 CAPA 的风险对患者进行分层。
单中心回顾性病例对照研究。病例定义为根据 2020 年 ECMM/ISHAM 共识标准诊断为 CAPA 的患者。为每个病例选择 2 名危重症 COVID-19 患者作为对照。
纳入 28 例 CAPA 患者和 56 例匹配对照。与 CAPA 相关的因素包括年龄较大（68 岁 vs. 62 岁，p=0.033）、主动吸烟（17.9% vs. 1.8%，p=0.014）、慢性呼吸道疾病（48.1% vs. 26.3%，p=0.043）、慢性肾功能衰竭（25.0% vs. 3.6%，p=0.005）、慢性皮质激素治疗（28.6% vs. 1.8%，p<0.001）、托珠单抗治疗（92.9% vs. 66.1%，p=0.008）和 ICU 入院时高急性生理与慢性健康状况评分 II（中位数 13 分 vs. 10 分，p=0.026）。创建了一个包含这些变量的评分，其受试者工作特征曲线下面积为 0.854（95%CI 0.77-0.92）。评分低于 6 分的阴性预测值为 99.6%。评分 10 分或更高的阳性预测值为 27.9%。
我们提出了一种临床预测评分，可以根据发生 CAPA 的风险对危重症 COVID-19 患者进行分层。该 CAPA 评分可用于靶向预防措施。需要进一步评估该评分以及这些靶向预防措施的效用。
