tetano
Editor, Senior Moderator
Cureus
. 2021 Aug 7;13(8):e16982.
doi: 10.7759/cureus.16982. eCollection 2021 Aug.
COVID-Associated Pulmonary Aspergillosis and Its Related Outcomes: A Single-Center Prospective Observational Study
Ahtesham Iqbal[SUP] 1 [/SUP], Moazma Ramzan[SUP] 1 [/SUP], Aftab Akhtar[SUP] 2 [/SUP], Anam Ahtesham[SUP] 3 [/SUP], Seemal Aslam[SUP] 4 [/SUP], Javeria Khalid[SUP] 5 [/SUP]
Affiliations
Abstract
Background and objective Invasive pulmonary aspergillosis (IPA) is a frequent complication among neutropenic patients. It is increasingly being reported in critical coronavirus disease 2019 (COVID-19) patients requiring ICU admission and invasive mechanical ventilation (IMV) and is known as COVID-associated pulmonary aspergillosis (CAPA). We conducted this large prospective observational study to determine the frequency of CAPA and its outcomes in the ICU population. Methodology This was a prospective observational study. We recruited 307 reverse transcription-polymerase chain reaction (RT-PCR)-confirmed cases of severe COVID-19 pneumonia requiring IMV. We excluded those who did not require IMV or had been transferred out to other hospitals. The Chi-square test was applied to find the association between categorical variables. A p-value of <0.05 was considered statistically significant. Results Out of the 307 cases of mechanically ventilated COVID-19 pneumonia, 61 had probable CAPA. The median age was 60 years. Malignancy and cirrhosis were significant risk factors associated with CAPA (p=<0.001, 0.001, respectively). Aspergillus fumigatus was detected in 78.7% of the cases. The median length of ICU stay was 11 days [interquartile range (IQR): 4-14]. Among CAPA cases, 70.5% developed septic shock and required ionotropic support. Among 61 probable cases of CAPA, 91.8% did not survive and there was a strong correlation between CAPA and ICU mortality (p=0.001). Conclusion We concluded that CAPA is a fatal complication of severe COVID-19 pneumonia and is associated with increased mortality.
Keywords: covid associated pulmonary aspergillosis; invasive mechanical ventilation; outcome; probable capa; severe covid pneumonia.
. 2021 Aug 7;13(8):e16982.
doi: 10.7759/cureus.16982. eCollection 2021 Aug.
COVID-Associated Pulmonary Aspergillosis and Its Related Outcomes: A Single-Center Prospective Observational Study
Ahtesham Iqbal[SUP] 1 [/SUP], Moazma Ramzan[SUP] 1 [/SUP], Aftab Akhtar[SUP] 2 [/SUP], Anam Ahtesham[SUP] 3 [/SUP], Seemal Aslam[SUP] 4 [/SUP], Javeria Khalid[SUP] 5 [/SUP]
Affiliations
- PMID: 34527462
- PMCID: PMC8421057
- DOI: 10.7759/cureus.16982
Abstract
Background and objective Invasive pulmonary aspergillosis (IPA) is a frequent complication among neutropenic patients. It is increasingly being reported in critical coronavirus disease 2019 (COVID-19) patients requiring ICU admission and invasive mechanical ventilation (IMV) and is known as COVID-associated pulmonary aspergillosis (CAPA). We conducted this large prospective observational study to determine the frequency of CAPA and its outcomes in the ICU population. Methodology This was a prospective observational study. We recruited 307 reverse transcription-polymerase chain reaction (RT-PCR)-confirmed cases of severe COVID-19 pneumonia requiring IMV. We excluded those who did not require IMV or had been transferred out to other hospitals. The Chi-square test was applied to find the association between categorical variables. A p-value of <0.05 was considered statistically significant. Results Out of the 307 cases of mechanically ventilated COVID-19 pneumonia, 61 had probable CAPA. The median age was 60 years. Malignancy and cirrhosis were significant risk factors associated with CAPA (p=<0.001, 0.001, respectively). Aspergillus fumigatus was detected in 78.7% of the cases. The median length of ICU stay was 11 days [interquartile range (IQR): 4-14]. Among CAPA cases, 70.5% developed septic shock and required ionotropic support. Among 61 probable cases of CAPA, 91.8% did not survive and there was a strong correlation between CAPA and ICU mortality (p=0.001). Conclusion We concluded that CAPA is a fatal complication of severe COVID-19 pneumonia and is associated with increased mortality.
Keywords: covid associated pulmonary aspergillosis; invasive mechanical ventilation; outcome; probable capa; severe covid pneumonia.