呼吸亚重症监护病房急性呼吸衰竭患者 COVID-19 相关肺曲霉病的危险因素及转归。

Risk factors for COVID-19 associated pulmonary aspergillosis and outcomes in patients with acute respiratory failure in a respiratory sub-intensive care unit.

机构信息

Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

出版信息

BMC Infect Dis. 2024 Apr 11;24(1):392. doi: 10.1186/s12879-024-09283-3.

DOI:10.1186/s12879-024-09283-3

PMID:38605300

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11007928/

Abstract

BACKGROUND

COVID-19-associated pulmonary aspergillosis (CAPA) is burdened by high mortality. Data are lacking about non-ICU patients. Aims of this study were to: (i) assess the incidence and prevalence of CAPA in a respiratory sub-intensive care unit, (ii) evaluate its risk factors and (iii) impact on in-hospital mortality. Secondary aims were to: (i) assess factors associated to mortality, and (ii) evaluate significant features in hematological patients.

MATERIALS AND METHODS

This was a single-center, retrospective study of COVID-19 patients with acute respiratory failure. A cohort of CAPA patients was compared to a non-CAPA cohort. Among patients with CAPA, a cohort of hematological patients was further compared to another of non-hematological patients.

RESULTS

Three hundred fifty patients were included in the study. Median P/F ratio at the admission to sub-intensive unit was 225 mmHg (IQR 155-314). 55 (15.7%) developed CAPA (incidence of 5.5%). Eighteen had probable CAPA (37.3%), 37 (67.3%) possible CAPA and none proven CAPA. Diagnosis of CAPA occurred at a median of 17 days (IQR 12-31) from SARS-CoV-2 infection. Independent risk factors for CAPA were hematological malignancy [OR 1.74 (95%CI 0.75-4.37), p = 0.0003], lymphocytopenia [OR 2.29 (95%CI 1.12-4.86), p = 0.02], and COPD [OR 2.74 (95%CI 1.19-5.08), p = 0.014]. Mortality rate was higher in CAPA cohort (61.8% vs 22.7%, p < 0.0001). CAPA resulted an independent risk factor for in-hospital mortality [OR 2.92 (95%CI 1.47-5.89), p = 0.0024]. Among CAPA patients, age > 65 years resulted a predictor of mortality [OR 5.09 (95% CI 1.20-26.92), p = 0.035]. No differences were observed in hematological cohort.

CONCLUSION

CAPA is a life-threatening condition with high mortality rates. It should be promptly suspected, especially in case of hematological malignancy, COPD and lymphocytopenia.

摘要

背景

COVID-19 相关肺曲霉病（CAPA）死亡率高。非 ICU 患者的数据缺乏。本研究的目的是：（i）评估呼吸亚重症监护病房中 CAPA 的发病率和患病率，（ii）评估其危险因素和（iii）对住院死亡率的影响。次要目的是：（i）评估与死亡率相关的因素，和（ii）评估血液系统患者的显著特征。

材料和方法

这是一项对急性呼吸衰竭的 COVID-19 患者进行的单中心回顾性研究。CAPA 患者队列与非 CAPA 队列进行比较。在 CAPA 患者中，血液系统患者队列与非血液系统患者队列进一步比较。

结果

350 名患者纳入研究。亚重症监护病房入院时的 P/F 比值中位数为 225mmHg（IQR 155-314）。55 例（15.7%）发生 CAPA（发病率为 5.5%）。18 例为疑似 CAPA（37.3%），37 例（67.3%）为可能 CAPA，无一例为确诊 CAPA。CAPA 的诊断发生在 SARS-CoV-2 感染后的中位数 17 天（IQR 12-31）。CAPA 的独立危险因素为血液系统恶性肿瘤[OR 1.74（95%CI 0.75-4.37），p=0.0003]、淋巴细胞减少[OR 2.29（95%CI 1.12-4.86），p=0.02]和 COPD[OR 2.74（95%CI 1.19-5.08），p=0.014]。CAPA 组死亡率更高（61.8% vs 22.7%，p<0.0001）。CAPA 是住院死亡率的独立危险因素[OR 2.92（95%CI 1.47-5.89），p=0.0024]。在 CAPA 患者中，年龄>65 岁是死亡率的预测因素[OR 5.09（95%CI 1.20-26.92），p=0.035]。在血液学队列中未观察到差异。