Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2022 May 9;37(18):e134. doi: 10.3346/jkms.2022.37.e134.
Coronavirus disease 2019 (COVID-19) is often accompanied by secondary infections, such as invasive aspergillosis. In this study, risk factors for developing COVID-19-associated pulmonary aspergillosis (CAPA) and their clinical outcomes were evaluated.
This multicenter retrospective cohort study included critically ill COVID-19 patients from July 2020 through March 2021. Critically ill patients were defined as patients requiring high-flow respiratory support or mechanical ventilation. CAPA was defined based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus criteria. Factors associated with CAPA were analyzed, and their clinical outcomes were adjusted by a propensity score-matched model.
Among 187 eligible patients, 17 (9.1%) developed CAPA, which is equal to 33.10 per 10,000 patient-days. Sixteen patients received voriconazole-based antifungal treatment. In addition, 82.4% and 53.5% of patients with CAPA and without CAPA, respectively, received early high-dose corticosteroids ( = 0.022). In multivariable analysis, initial 10-day cumulative steroid dose > 60 mg of dexamethasone or dexamethasone equivalent dose) (adjusted odds ratio [OR], 3.77; 95% confidence interval [CI], 1.03-13.79) and chronic pulmonary disease (adjusted OR, 4.20; 95% CI, 1.26-14.02) were independently associated with CAPA. Tendencies of higher 90-day overall mortality (54.3% vs. 35.2%, = 0.346) and lower respiratory support-free rate were observed in patients with CAPA (76.3% vs. 54.9%, = 0.089).
Our study showed that the dose of corticosteroid use might be a risk factor for CAPA development and the possibility of CAPA contributing to adverse outcomes in critically ill COVID-19 patients.
新型冠状病毒病 2019（COVID-19）常伴有继发性感染，如侵袭性曲霉病。本研究评估了 COVID-19 相关肺曲霉病（CAPA）发生的危险因素及其临床结局。
本多中心回顾性队列研究纳入了 2020 年 7 月至 2021 年 3 月期间患有危重症 COVID-19 的患者。危重症患者定义为需要高流量呼吸支持或机械通气的患者。CAPA 根据 2020 年欧洲医学真菌学联合会和国际人类与动物真菌学会共识标准定义。分析了与 CAPA 相关的因素，并通过倾向评分匹配模型调整了其临床结局。
在 187 名符合条件的患者中，有 17 名（9.1%）发生了 CAPA，相当于每 10000 患者日发生 33.10 例。16 名患者接受了伏立康唑为基础的抗真菌治疗。此外，分别有 82.4%和 53.5%的 CAPA 患者和无 CAPA 患者接受了早期大剂量皮质类固醇治疗（=0.022）。多变量分析显示，初始 10 天累积类固醇剂量>60mg 地塞米松或地塞米松等效剂量（校正比值比[OR]，3.77；95%置信区间[CI]，1.03-13.79）和慢性肺部疾病（校正 OR，4.20；95%CI，1.26-14.02）与 CAPA 独立相关。CAPA 患者的 90 天总死亡率（54.3% vs. 35.2%，=0.346）和无呼吸支持存活率的趋势较高（76.3% vs. 54.9%，=0.089）。
本研究表明，皮质类固醇的使用剂量可能是 CAPA 发生的危险因素，以及 CAPA 可能导致危重症 COVID-19 患者不良结局的可能性。
