Annals of Intensive Care (Jan 2024)

Covid-19-associated pulmonary aspergillosis in mechanically ventilated patients: incidence and outcome in a French multicenter observational cohort (APICOVID)

  • Luc Desmedt,
  • Matthieu Raymond,
  • Aurélie Le Thuaut,
  • Pierre Asfar,
  • Cédric Darreau,
  • Florian Reizine,
  • Gwenhaël Colin,
  • Johann Auchabie,
  • Julien Lorber,
  • Béatrice La Combe,
  • Pierre Kergoat,
  • Baptiste Hourmant,
  • Agathe Delbove,
  • Aurélien Frérou,
  • Jean Morin,
  • Pierre Yves Ergreteau,
  • Philippe Seguin,
  • Maëlle Martin,
  • Jean Reignier,
  • Jean-Baptiste Lascarrou,
  • Emmanuel Canet

DOI
https://doi.org/10.1186/s13613-023-01229-3
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 9

Abstract

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Abstract Background Recent studies identified coronavirus disease 2019 (COVID-19) as a risk factor for invasive pulmonary aspergillosis (IPA) but produced conflicting data on IPA incidence and impact on patient outcomes. We aimed to determine the incidence and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) in mechanically ventilated patients. Methods We performed a multicenter retrospective observational cohort study in consecutive adults admitted to 15 French intensive care units (ICUs) in 2020 for COVID-19 requiring mechanical ventilation. CAPA was diagnosed and graded according to 2020 ECMM/ISHAM consensus criteria. The primary objective was to determine the incidence of proven/probable CAPA, and the secondary objectives were to identify risk factors for proven/probable CAPA and to assess associations between proven/probable CAPA and patient outcomes. Results The 708 included patients (522 [73.7%] men) had a mean age of 65.2 ± 10.8 years, a median mechanical ventilation duration of 15.0 [8.0–27.0] days, and a day-90 mortality rate of 28.5%. Underlying immunosuppression was present in 113 (16.0%) patients. Corticosteroids were used in 348 (63.1%) patients. Criteria for probable CAPA were met by 18 (2.5%) patients; no patient had histologically proven CAPA. Older age was the only factor significantly associated with probable CAPA (hazard ratio [HR], 1.04; 95% CI 1.00–1.09; P = 0.04). Probable CAPA was associated with significantly higher day-90 mortality (HR, 2.07; 95% CI 1.32–3.25; P = 0.001) but not with longer mechanical ventilation or ICU length of stay. Conclusion Probable CAPA is a rare but serious complication of severe COVID-19 requiring mechanical ventilation and is associated with higher day-90 mortality. Graphical Abstract

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