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Risk factors and clinical impact of COVID-19-associated pulmonary aspergillosis: Multicenter retrospective cohort

Raeseok Lee1,2, Sung-Yeon Cho1,2, Dong-Gun Lee1,2

  • 1Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

The Korean Journal of Internal Medicine
|May 25, 2022
PubMed

Insights

COVID-19-associated pulmonary aspergillosis (CAPA) is common in critically ill patients. Daily high-dose corticosteroid use predicts CAPA and increases mortality, necessitating avoidance of high-dose steroids post-inflammation and active CAPA surveillance.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Critical Care Medicine

Background:

  • COVID-19-associated pulmonary aspergillosis (CAPA) risk factors and clinical impact are debated.
  • No prior data on CAPA epidemiology in Korea exists.

Purpose of the Study:

  • Investigate CAPA epidemiology in Korea.
  • Identify CAPA predictors and clinical outcome impacts.
  • Evaluate diagnostic efforts for CAPA.

Main Methods:

  • Retrospective analysis of severely to critically ill COVID-19 patients (n=218) from January 2020 to May 2021.
  • Detailed corticosteroid use (dose, duration) was subcategorized.
  • Statistical analysis to identify predictors and mortality impact.

Main Results:

  • CAPA diagnosed in 4.6% of hospitalized and 11.2% of ICU patients.
  • Independent predictors for CAPA: total cumulative and daily high-dose corticosteroid use.
  • Daily high-dose steroid use significantly increased 30-day mortality (HR 5.645).

Conclusions:

  • CAPA is prevalent in critically ill COVID-19 patients.
  • Daily high-dose corticosteroid use is a key predictor and associated with increased mortality.
  • Avoid high-dose corticosteroids post-inflammatory phase and implement active CAPA surveillance in high-risk patients.
Abstract

Keywords:
COVID-19Invasive pulmonary aspergillosisMortalityRiskSteroids

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