Volpi Sara, Kaleci Shaniko, Franceschini Erica, Cantergiani Samuele, Orlando Gabriella, Cervo Adriana, Bedini Andrea, Casolari Stefania, Esperti Sara, Chemello Davide, Albertini Maddalena, Cancian Laura, Buonadonna Paola, Baldi Jacopo, Tonelli Roberto, Busani Stefano, Serio Lucia, Brugioni Lucio, Pietrangelo Antonello, Melegari Gabriele, Pinelli Giovanni, Venturelli Claudia, Venturelli Irene, Girardis Massimo, Sarti Mario, Mussini Cristina, Meschiari Marianna
Infectious Disease Department, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Open Forum Infect Dis. 2025 Mar 14;12(4):ofaf159. doi: 10.1093/ofid/ofaf159. eCollection 2025 Apr.
Our aim was to compare epidemiological, clinical and treatment characteristics, and outcomes between patients with diagnoses of coronavirus disease 2019-associated pulmonary aspergillosis (CAPA) or putative invasive pulmonary aspergillosis (PIPA), without hematological cancers.
Retrospective, monocentric comparative observational cohort study, including nonhematological patients treated for invasive pulmonary aspergillosis between 2018 and 2022. Primary study end points were risk factors for 30-day mortality and clinical failure. To account for the imbalance in antifungal treatment allocation, a propensity score weighting approach was adopted.
A total of 209 patients were included, 93 (44.5%) with CAPA and 116 (55.5%) with PIPA; 144 (68.9%) we admitted to the intensive care unit. Patients with PIPA had higher Charlson Comorbidity Index values (mean [SD], 5.8 [2.6]; range, 0-14) and higher prevalences of chronic obstructive pulmonary disease (30.7%), solid cancer (36.8%), liver cirrhosis (12.3%), and concomitant immunosuppressive therapies (26.1%). Patients with CAPA received more invasive mechanical ventilation (70.5%) and corticosteroids (90.1%), more frequently had positive galactomannan (GM) results with bronchoalveolar lavage (80.5%), and had longer mean hospital stays (62.7 [SD, 52.1; range, 8-276] days) and intensive care unit stays (36 [30.7; 2-168] days). No differences in clinical cure or mortality rates were observed between groups. In multivariable analysis, isavuconazole was the only independent factor for clinical cure, reported also in the propensity score matching analysis (odds ratio, 0.41 [95% confidence interval, .16-1.03]; = .06). A positive serum GM result was independently associated with 30-day mortality (hazard ratio, 1.78 [95% confidence interval, 1.02-3.10]; = .04).
Patients with CAPA have fewer comorbid conditions and higher fungal burden than those with PIPA, but clinical outcomes are similar between groups. Isavuconazole was an independent predictor for clinical cure, and serum GM positivity an independent predictor for 30-day mortality.
我们的目的是比较2019冠状病毒病相关肺曲霉病（CAPA）或疑似侵袭性肺曲霉病（PIPA）且无血液系统癌症患者的流行病学、临床和治疗特征及结局。
回顾性、单中心比较观察性队列研究，纳入2018年至2022年间接受侵袭性肺曲霉病治疗的非血液系统患者。主要研究终点为30天死亡率和临床失败的危险因素。为解决抗真菌治疗分配不均衡问题，采用倾向评分加权法。
共纳入209例患者，93例（44.5%）为CAPA，116例（55.5%）为PIPA；144例（68.9%）入住重症监护病房。PIPA患者的Charlson合并症指数值更高（均值[标准差]，5.8[2.6]；范围，0 - 14），慢性阻塞性肺疾病（30.7%）、实体癌（36.8%）、肝硬化（12.3%）及同时使用免疫抑制治疗（26.1%）的患病率更高。CAPA患者接受有创机械通气（70.5%）和皮质类固醇治疗（90.1%）的比例更高，支气管肺泡灌洗半乳甘露聚糖（GM）检测结果阳性的频率更高（80.5%），平均住院时间更长（62.7[标准差52.1；范围，8 - 276]天），重症监护病房住院时间更长（36[30.7；2 - 168]天）。两组间临床治愈率或死亡率无差异。多变量分析中，艾沙康唑是临床治愈的唯一独立因素，倾向评分匹配分析中也有报道（比值比，0.41[95%置信区间，0.16 - 1.03]；P = 0.06）。血清GM检测结果阳性与30天死亡率独立相关（风险比，1.78[95%置信区间，1.02 - 3.10]；P = 0.04）。
与PIPA患者相比，CAPA患者的合并症较少，真菌负荷较高，但两组临床结局相似。艾沙康唑是临床治愈的独立预测因素，血清GM阳性是30天死亡率的独立预测因素。
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