tetano
Editor, Senior Moderator
J Clin Microbiol
. 2022 Mar 24;e0229821.
doi: 10.1128/jcm.02298-21. Online ahead of print.
Prognostic Impact of Bronchoalveolar Lavage Fluid Galactomannan and Aspergillus Culture Results on Survival in COVID-19 Intensive Care Unit Patients: a Post Hoc Analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-Associated Pulmonary Aspergillosis Study
Daniele Roberto Giacobbe[SUP] #[/SUP][SUP] 1 2 [/SUP], Juergen Prattes[SUP] #[/SUP][SUP] 3 [/SUP], Joost Wauters[SUP] 4 [/SUP], Silvia Dettori[SUP] 1 2 [/SUP], Alessio Signori[SUP] 5 [/SUP], Jon Salmanton-García[SUP] 6 7 [/SUP], Johan Maertens[SUP] 4 [/SUP], Marc Bourgeois[SUP] 8 [/SUP], Marijke Reynders[SUP] 8 [/SUP], Lynn Rutsaert[SUP] 9 [/SUP], Niels Van Regenmortel[SUP] 9 [/SUP], Piet Lormans[SUP] 10 [/SUP], Simon Feys[SUP] 4 [/SUP], Nikolay Klimko[SUP] 11 [/SUP], Olga Shadrivova[SUP] 11 [/SUP], Oliver A Cornely[SUP] 6 12 13 14 [/SUP], Riina Rautemaa-Richardson[SUP] 15 16 [/SUP], Philipp Koehler[SUP] 6 7 [/SUP], Katrien Lagrou[SUP] 17 18 [/SUP], Matteo Bassetti[SUP] #[/SUP][SUP] 1 2 [/SUP], Martin Hoenigl[SUP] #[/SUP][SUP] 3 19 20 [/SUP], ECMM-CAPA Study Group
Affiliations
Abstract
Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), which impacts their chances of survival. Whether positive bronchoalveolar lavage fluid (BALF) mycological tests can be used as a survival proxy remains unknown. We conducted a post hoc analysis of a previous multicenter, multinational observational study with the aim of assessing the differential prognostic impact of BALF mycological tests, namely, positive (optical density index of ≥1.0) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination for critically ill patients with COVID-19. Of the 592 critically ill patients with COVID-19 enrolled in the main study, 218 were included in this post hoc analysis, as they had both test results available. CAPA was diagnosed in 56/218 patients (26%). Most cases were probable CAPA (51/56 [91%]) and fewer were proven CAPA (5/56 [9%]). In the final multivariable model adjusted for between-center heterogeneity, an independent association with 90-day mortality was observed for the combination of positive BALF GM and positive BALF Aspergillus culture in comparison with both tests negative (hazard ratio, 2.53; 95% CI confidence interval [CI], 1.28 to 5.02; P = 0.008). The other independent predictors of 90-day mortality were increasing age and active malignant disease. In conclusion, the combination of positive BALF GM and positive BALF Aspergillus culture was associated with increased 90-day mortality in critically ill patients with COVID-19. Additional study is needed to explore the possible prognostic value of other BALF markers.
Keywords: Aspergillus; BALF; CAPA; COVID-19; GM; biomarker; galactomannan.
. 2022 Mar 24;e0229821.
doi: 10.1128/jcm.02298-21. Online ahead of print.
Prognostic Impact of Bronchoalveolar Lavage Fluid Galactomannan and Aspergillus Culture Results on Survival in COVID-19 Intensive Care Unit Patients: a Post Hoc Analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-Associated Pulmonary Aspergillosis Study
Daniele Roberto Giacobbe[SUP] #[/SUP][SUP] 1 2 [/SUP], Juergen Prattes[SUP] #[/SUP][SUP] 3 [/SUP], Joost Wauters[SUP] 4 [/SUP], Silvia Dettori[SUP] 1 2 [/SUP], Alessio Signori[SUP] 5 [/SUP], Jon Salmanton-García[SUP] 6 7 [/SUP], Johan Maertens[SUP] 4 [/SUP], Marc Bourgeois[SUP] 8 [/SUP], Marijke Reynders[SUP] 8 [/SUP], Lynn Rutsaert[SUP] 9 [/SUP], Niels Van Regenmortel[SUP] 9 [/SUP], Piet Lormans[SUP] 10 [/SUP], Simon Feys[SUP] 4 [/SUP], Nikolay Klimko[SUP] 11 [/SUP], Olga Shadrivova[SUP] 11 [/SUP], Oliver A Cornely[SUP] 6 12 13 14 [/SUP], Riina Rautemaa-Richardson[SUP] 15 16 [/SUP], Philipp Koehler[SUP] 6 7 [/SUP], Katrien Lagrou[SUP] 17 18 [/SUP], Matteo Bassetti[SUP] #[/SUP][SUP] 1 2 [/SUP], Martin Hoenigl[SUP] #[/SUP][SUP] 3 19 20 [/SUP], ECMM-CAPA Study Group
Affiliations
- PMID: 35321555
- DOI: 10.1128/jcm.02298-21
Abstract
Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), which impacts their chances of survival. Whether positive bronchoalveolar lavage fluid (BALF) mycological tests can be used as a survival proxy remains unknown. We conducted a post hoc analysis of a previous multicenter, multinational observational study with the aim of assessing the differential prognostic impact of BALF mycological tests, namely, positive (optical density index of ≥1.0) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination for critically ill patients with COVID-19. Of the 592 critically ill patients with COVID-19 enrolled in the main study, 218 were included in this post hoc analysis, as they had both test results available. CAPA was diagnosed in 56/218 patients (26%). Most cases were probable CAPA (51/56 [91%]) and fewer were proven CAPA (5/56 [9%]). In the final multivariable model adjusted for between-center heterogeneity, an independent association with 90-day mortality was observed for the combination of positive BALF GM and positive BALF Aspergillus culture in comparison with both tests negative (hazard ratio, 2.53; 95% CI confidence interval [CI], 1.28 to 5.02; P = 0.008). The other independent predictors of 90-day mortality were increasing age and active malignant disease. In conclusion, the combination of positive BALF GM and positive BALF Aspergillus culture was associated with increased 90-day mortality in critically ill patients with COVID-19. Additional study is needed to explore the possible prognostic value of other BALF markers.
Keywords: Aspergillus; BALF; CAPA; COVID-19; GM; biomarker; galactomannan.