tetano
Editor, Senior Moderator
Ann Intensive Care
. 2024 Jan 29;14(1):17.
doi: 10.1186/s13613-023-01229-3. Covid-19-associated pulmonary aspergillosis in mechanically ventilated patients: incidence and outcome in a French multicenter observational cohort (APICOVID)
Luc Desmedt[SUP] 1 [/SUP], Matthieu Raymond[SUP] 2 [/SUP], Aurélie Le Thuaut[SUP] 3 [/SUP], Pierre Asfar[SUP] 4 [/SUP], Cédric Darreau[SUP] 5 [/SUP], Florian Reizine[SUP] 6 [/SUP], Gwenhaël Colin[SUP] 7 [/SUP], Johann Auchabie[SUP] 8 [/SUP], Julien Lorber[SUP] 9 [/SUP], Béatrice La Combe[SUP] 10 [/SUP], Pierre Kergoat[SUP] 11 [/SUP], Baptiste Hourmant[SUP] 12 [/SUP], Agathe Delbove[SUP] 13 [/SUP], Aurélien Frérou[SUP] 14 [/SUP], Jean Morin[SUP] 15 [/SUP], Pierre Yves Ergreteau[SUP] 16 [/SUP], Philippe Seguin[SUP] 17 [/SUP], Maëlle Martin[SUP] 2 [/SUP], Jean Reignier[SUP] 18 [/SUP], Jean-Baptiste Lascarrou[SUP] 18 [/SUP], Emmanuel Canet[SUP] 19 [/SUP]
Affiliations
Background: Recent studies identified coronavirus disease 2019 (COVID-19) as a risk factor for invasive pulmonary aspergillosis (IPA) but produced conflicting data on IPA incidence and impact on patient outcomes. We aimed to determine the incidence and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) in mechanically ventilated patients.
Methods: We performed a multicenter retrospective observational cohort study in consecutive adults admitted to 15 French intensive care units (ICUs) in 2020 for COVID-19 requiring mechanical ventilation. CAPA was diagnosed and graded according to 2020 ECMM/ISHAM consensus criteria. The primary objective was to determine the incidence of proven/probable CAPA, and the secondary objectives were to identify risk factors for proven/probable CAPA and to assess associations between proven/probable CAPA and patient outcomes.
Results: The 708 included patients (522 [73.7%] men) had a mean age of 65.2 ± 10.8 years, a median mechanical ventilation duration of 15.0 [8.0-27.0] days, and a day-90 mortality rate of 28.5%. Underlying immunosuppression was present in 113 (16.0%) patients. Corticosteroids were used in 348 (63.1%) patients. Criteria for probable CAPA were met by 18 (2.5%) patients; no patient had histologically proven CAPA. Older age was the only factor significantly associated with probable CAPA (hazard ratio
, 1.04; 95% CI 1.00-1.09; P = 0.04). Probable CAPA was associated with significantly higher day-90 mortality (HR, 2.07; 95% CI 1.32-3.25; P = 0.001) but not with longer mechanical ventilation or ICU length of stay.
Conclusion: Probable CAPA is a rare but serious complication of severe COVID-19 requiring mechanical ventilation and is associated with higher day-90 mortality.
Keywords: COVID‑19; Intensive care unit; Invasive pulmonary aspergillosis; Mechanical ventilation.
. 2024 Jan 29;14(1):17.
doi: 10.1186/s13613-023-01229-3. Covid-19-associated pulmonary aspergillosis in mechanically ventilated patients: incidence and outcome in a French multicenter observational cohort (APICOVID)
Luc Desmedt[SUP] 1 [/SUP], Matthieu Raymond[SUP] 2 [/SUP], Aurélie Le Thuaut[SUP] 3 [/SUP], Pierre Asfar[SUP] 4 [/SUP], Cédric Darreau[SUP] 5 [/SUP], Florian Reizine[SUP] 6 [/SUP], Gwenhaël Colin[SUP] 7 [/SUP], Johann Auchabie[SUP] 8 [/SUP], Julien Lorber[SUP] 9 [/SUP], Béatrice La Combe[SUP] 10 [/SUP], Pierre Kergoat[SUP] 11 [/SUP], Baptiste Hourmant[SUP] 12 [/SUP], Agathe Delbove[SUP] 13 [/SUP], Aurélien Frérou[SUP] 14 [/SUP], Jean Morin[SUP] 15 [/SUP], Pierre Yves Ergreteau[SUP] 16 [/SUP], Philippe Seguin[SUP] 17 [/SUP], Maëlle Martin[SUP] 2 [/SUP], Jean Reignier[SUP] 18 [/SUP], Jean-Baptiste Lascarrou[SUP] 18 [/SUP], Emmanuel Canet[SUP] 19 [/SUP]
Affiliations
- PMID: 38285382
- DOI: 10.1186/s13613-023-01229-3
Background: Recent studies identified coronavirus disease 2019 (COVID-19) as a risk factor for invasive pulmonary aspergillosis (IPA) but produced conflicting data on IPA incidence and impact on patient outcomes. We aimed to determine the incidence and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) in mechanically ventilated patients.
Methods: We performed a multicenter retrospective observational cohort study in consecutive adults admitted to 15 French intensive care units (ICUs) in 2020 for COVID-19 requiring mechanical ventilation. CAPA was diagnosed and graded according to 2020 ECMM/ISHAM consensus criteria. The primary objective was to determine the incidence of proven/probable CAPA, and the secondary objectives were to identify risk factors for proven/probable CAPA and to assess associations between proven/probable CAPA and patient outcomes.
Results: The 708 included patients (522 [73.7%] men) had a mean age of 65.2 ± 10.8 years, a median mechanical ventilation duration of 15.0 [8.0-27.0] days, and a day-90 mortality rate of 28.5%. Underlying immunosuppression was present in 113 (16.0%) patients. Corticosteroids were used in 348 (63.1%) patients. Criteria for probable CAPA were met by 18 (2.5%) patients; no patient had histologically proven CAPA. Older age was the only factor significantly associated with probable CAPA (hazard ratio
, 1.04; 95% CI 1.00-1.09; P = 0.04). Probable CAPA was associated with significantly higher day-90 mortality (HR, 2.07; 95% CI 1.32-3.25; P = 0.001) but not with longer mechanical ventilation or ICU length of stay.
Conclusion: Probable CAPA is a rare but serious complication of severe COVID-19 requiring mechanical ventilation and is associated with higher day-90 mortality.
Keywords: COVID‑19; Intensive care unit; Invasive pulmonary aspergillosis; Mechanical ventilation.