National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Department of Respiratory Medicine, Capital Medical University, Beijing, China.
Eur J Clin Microbiol Infect Dis. 2024 Apr;43(4):683-692. doi: 10.1007/s10096-024-04772-4. Epub 2024 Feb 7.
We conducted a monocentric retrospective study using the latest definitions to compare the demographic, clinical, and biological characteristics of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA).
The study retrospectively enrolled 180 patients, including 70 influenza/IPA patients (with positive influenza A/B and Aspergillus) and 110 COVID-19/IPA patients (with positive SARS-CoV-2 and Aspergillus). Among them, 42 (60%) and 30 (27.3%) patients fulfilled the definitions of IAPA and CAPA, respectively.
The CAPA patients had significantly higher in-hospital mortality (13/31, 41.9%) than IAPA patients (8/42, 19%) with a P-value of 0.033. Kaplan-Meier survival curve also showed significantly higher 30-day mortality for CAPA patients (P = 0.025). Additionally, the CAPA patients were older, though insignificantly, than IAPA patients (70 (60-80) vs. 62 (52-72), P = 0.075). A lower percentage of chronic pulmonary disease (12.9 vs. 40.5%, P = 0.01) but higher corticosteroids use 7 days before and after ICU admission (22.6% vs. 0%, P = 0.002) were found in CAPA patients. Notably, there were no significant differences in the percentage of ICU admission or ICU mortality between the two groups. In addition, the time from observation to Aspergillus diagnosis was significantly longer in CAPA patients than in IAPA patients (7 (2-13) vs. 0 (0-4.5), P = 0.048).
Patients infected with SARS-CoV-2 and Aspergillus during the concentrated outbreak of COVID-19 in China had generally higher in-hospital mortality but a lower percentage of chronic pulmonary disease than those infected with influenza and Aspergillus. For influenza-infected patients who require hospitalization, close attention should be paid to the risk of invasive aspergillosis upfront.
本研究采用最新定义，进行了一项单中心回顾性研究，旨在比较流感相关侵袭性肺曲霉病（IAPA）和 COVID-19 相关侵袭性肺曲霉病（CAPA）的人口统计学、临床和生物学特征。
本研究回顾性纳入了 180 例患者，包括 70 例流感/IPA 患者（流感 A/B 和曲霉菌均阳性）和 110 例 COVID-19/IPA 患者（SARS-CoV-2 和曲霉菌均阳性）。其中，42 例（60%）和 30 例（27.3%）患者符合 IAPA 和 CAPA 的定义。
CAPA 患者的院内死亡率（13/31，41.9%）显著高于 IAPA 患者（8/42，19%），P 值为 0.033。Kaplan-Meier 生存曲线也显示 CAPA 患者的 30 天死亡率显著更高（P=0.025）。此外，CAPA 患者虽然年龄无显著差异，但略高于 IAPA 患者（70（60-80）vs. 62（52-72），P=0.075）。CAPA 患者慢性肺部疾病的比例较低（12.9% vs. 40.5%，P=0.01），但 ICU 入住前后 7 天使用皮质类固醇的比例较高（22.6% vs. 0%，P=0.002）。值得注意的是，两组患者的 ICU 入住率或 ICU 死亡率无显著差异。此外，CAPA 患者从观察到曲霉病诊断的时间明显长于 IAPA 患者（7（2-13）vs. 0（0-4.5），P=0.048）。
在中国 COVID-19 集中爆发期间，感染 SARS-CoV-2 和曲霉菌的患者总体上院内死亡率较高，但慢性肺部疾病的比例较低，而感染流感和曲霉菌的患者则较低。对于需要住院的流感感染患者，应提前关注侵袭性曲霉病的风险。
