Mary Wilson
Well-known member
1 September 2023
http://dx.doi. org/10.1136/thorax-2023- 220002).
William Hurt,1,2,3 Jonathan Youngs,1,2 Jonathan Ball,4 Jonathan Edgeworth,5, Philip Hopkins,6 David R Jenkins,7 Susannah Leaver,4 Andrea Mazzella,1 Síle F Molloy,1Silke Schelenz,8 Matt P Wise,9 P Lewis White,10 Hakeem Yusuff,11 Duncan Wyncoll,12Tihana Bicanic1,2,3
ABSTRACT
Background
Invasive pulmonary aspergillosis is a complication of severe COVID-19, with regional variation in reported incidence and mortality. We describe the incidence, risk factors and mortality associated with COVID-19-associated pulmonary aspergillosis (CAPA) in a prospective, multicentre UK cohort.
Methods
From March 2020 to March 2021, 266 mechanically ventilated adults with COVID-19 were enrolled across 5 UK hospital intensive care units (ICUs). CAPA was de ned using European Confederation for Medical Mycology and the International Society for Human and Animal Mycology criteria and fungal diagnostics performed on respiratory and serum samples.
Results
Twenty-nine of 266 patients (10.9%) had probable CAPA, 14 (5.2%) possible CAPA and none proven CAPA. Probable CAPA was diagnosed a median of 9 (IQR 7–16) days after ICU admission. Factors associated with probable CAPA after multivariable logistic regression were cumulative steroid dose
given within 28 days prior to ICU admission (adjusted OR (aOR) 1.16; 95% CI 1.01 to 1.43 per 100 mg prednisolone-equivalent), receipt of an interleukin (IL)-6 inhibitor (aOR 2.79; 95% CI 1.22 to 6.48) and chronic obstructive pulmonary disease (COPD) (aOR 4.78; 95% CI 1.13 to 18.13). Mortality in patients with probable CAPA was 55%, vs 46% in those without. After adjustment for immortal time bias, CAPA was associated with an increased risk of 90-day mortality (HR 1.85; 95% CI 1.07 to 3.19); however, this association did not remain statistically signi cant after further adjustment for confounders (adjusted HR 1.57; 95% CI 0.88 to 2.80). There was no difference in mortality between patients with CAPA prescribed antifungals (9 of 17; 53%) and those who were not (7 of 12; 58%) (p=0.77).
Interpretation
In this rst prospective UK study, probable CAPA was associated with corticosteroid use, receipt of IL-6 inhibitors and pre-existing COPD. CAPA did not impact mortality following adjustment for prognostic variables.
https://thorax.bmj.com/content/thoraxjnl/early/2023/09/01/thorax-2023-220002.full.pdf?with-ds=yes
http://dx.doi. org/10.1136/thorax-2023- 220002).
William Hurt,1,2,3 Jonathan Youngs,1,2 Jonathan Ball,4 Jonathan Edgeworth,5, Philip Hopkins,6 David R Jenkins,7 Susannah Leaver,4 Andrea Mazzella,1 Síle F Molloy,1Silke Schelenz,8 Matt P Wise,9 P Lewis White,10 Hakeem Yusuff,11 Duncan Wyncoll,12Tihana Bicanic1,2,3
ABSTRACT
Background
Invasive pulmonary aspergillosis is a complication of severe COVID-19, with regional variation in reported incidence and mortality. We describe the incidence, risk factors and mortality associated with COVID-19-associated pulmonary aspergillosis (CAPA) in a prospective, multicentre UK cohort.
Methods
From March 2020 to March 2021, 266 mechanically ventilated adults with COVID-19 were enrolled across 5 UK hospital intensive care units (ICUs). CAPA was de ned using European Confederation for Medical Mycology and the International Society for Human and Animal Mycology criteria and fungal diagnostics performed on respiratory and serum samples.
Results
Twenty-nine of 266 patients (10.9%) had probable CAPA, 14 (5.2%) possible CAPA and none proven CAPA. Probable CAPA was diagnosed a median of 9 (IQR 7–16) days after ICU admission. Factors associated with probable CAPA after multivariable logistic regression were cumulative steroid dose
given within 28 days prior to ICU admission (adjusted OR (aOR) 1.16; 95% CI 1.01 to 1.43 per 100 mg prednisolone-equivalent), receipt of an interleukin (IL)-6 inhibitor (aOR 2.79; 95% CI 1.22 to 6.48) and chronic obstructive pulmonary disease (COPD) (aOR 4.78; 95% CI 1.13 to 18.13). Mortality in patients with probable CAPA was 55%, vs 46% in those without. After adjustment for immortal time bias, CAPA was associated with an increased risk of 90-day mortality (HR 1.85; 95% CI 1.07 to 3.19); however, this association did not remain statistically signi cant after further adjustment for confounders (adjusted HR 1.57; 95% CI 0.88 to 2.80). There was no difference in mortality between patients with CAPA prescribed antifungals (9 of 17; 53%) and those who were not (7 of 12; 58%) (p=0.77).
Interpretation
In this rst prospective UK study, probable CAPA was associated with corticosteroid use, receipt of IL-6 inhibitors and pre-existing COPD. CAPA did not impact mortality following adjustment for prognostic variables.
https://thorax.bmj.com/content/thoraxjnl/early/2023/09/01/thorax-2023-220002.full.pdf?with-ds=yes