Title : Critical risk factors for COVID-19-associated pulmonary aspergillosis identified in hospitalised patients
Abstract:
Background: The long-term impact of coronavirus (COVID)-19 and the possibility of secondary infections have not yet been defined. Because COVID-19 has become a common community infection, patients are often hospitalised with COVID-19 accompanied by unrelated comorbidities (overlooked and secondary infections). This retrospective study investigated the risk factors and prevalence of COVID-19-associated pulmonary aspergillosis (CAPA) among hospitalised patients.
Methods: We analysed data from 912 patients hospitalised with COVID-19 in Taiwan between 1 April and 1 July 2022 to identify risk factors and CAPA prevalence.
Results: Among these patients, 36 (3.9%) were diagnosed with CAPA 23 d (median onset) after testing positive for COVID-19. Risk factors included age > 60 years, male sex, body weight < 40 kg, body mass index (BMI) < 17.5 kg/m², Charlson Comorbidity Index (CCI) > 5, and severe COVID-19. Patients with CAPA had leukopenia, lymphopenia, thrombocytopenia, renal dysfunction, hypoalbuminemia, and elevated inflammatory markers (C-reactive protein [CRP], D-dimer, ferritin, lactate dehydrogenase [LDH], and erythrocyte sedimentation [ES]). Systemic corticosteroids (particularly doses ≥ 480 mg hydrocortisone-equivalent within 90 d before/after infection) significantly increased CAPA risk. Remdesivir was associated with CAPA because it was administered to severely ill patients instead of direct causation. Antibiotic therapy increased fungal susceptibility and CAPA was linked to increased mortality rates (10.7% vs. 2.4%), prolonged quarantine (> 13 d), and delayed diagnosis, particularly among patients with milder initial symptoms.
Conclusions: Increased mortality and diagnostic delays are associated with multifactorial CAPA. Vigilance is required in ICUs and other settings regarding the customisation of treatment and prophylactic strategies.
