The risk factors for and outcomes of COVID-19 associated pulmonary aspergillosis (CAPA) in critically-ill COVID-19 patients: A single center, retrospective cohort study.

배경: COVID-19 increases the risk of invasive pulmonary aspergillosis. However, the risk factors for and the outcomes of COVID-19 associated pulmonary aspergillosis (CAPA) is reported differently from hospital to hospital and is not fully defined yet. We aim to identify the risk factors for and outcomes of CAPA in critically-ill COVID-19 patients. 방법: A single center retrospective cohort study was conducted in critically-ill COVID-19 patients with National Institute of Allergy and Infectious Disease Ordinal Scale of 6 or higher who admitted to a tertiary care hospital in South Korea from March 2020 to January 2022. CAPA was retrospectively defined using modified Aspergillosis in Intensive Care Unit (modified AspICU) criteria. 결과: A total of 269 critically-ill COVID-19 patients were hospitalized during the study period and 50 (18.6%) patients were diagnosed with CAPA (Table 1). The overall incidence of CAPA was 8.69 case per 1000 patient-day. (Figure 1) Median time from admission to CAPA diagnosis was 12 days. Multivariable analysis showed that receiving solid organ transplantation (odds ratio [OR] 4.716, 95% confidence intervals [CI] 1.137-19.556, p=0.033), mechanical ventilator use (OR 2.485, 95% CI 1.213-5.095, p=0.013), high dose steroid use (mean dose>1.5mg/kg/day) (OR 6.946, 95% CI 2.312-20.865, p=0.001), and having lymphopenia (OR 3.04, 95% CI 1.443-6.407, p=0.03) were independent risk factors for developing CAPA (Table 2,3). Patients with CAPA showed significantly higher 28-day mortality (46.0% vs. 15.5%, p<0.0001), in-hospital mortality (72.0% vs. 19.2%, p<0.0001) and longer hospital length of stay (31 vs. 16 days, p<0.001) compared to patients without CAPA. (Table 2) 결론: In this study, the severity of COVID-19, use of high dose steroid and immunocompromised conditions could be important risk factors for developing CAPA and CAPA diagnosis was associated with worse outcome. [ABSTRACT FROM AUTHOR]