Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study

Background: Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs), but risk factors for COVID-19-associated IPA (CAPA) have not been fully characterized. The aim of the current study was to id...

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Autores principales:	Jiqian Xu, Xiaobo Yang, Zheng Lv, Ting Zhou, Hong Liu, Xiaojing Zou, Fengsheng Cao, Lu Zhang, Boyi Liu, Wei Chen, Yuan Yu, Huaqing Shu, Shiying Yuan, Ming Hu, Chaolin Huang, You Shang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	COVID-19 CAPA methylprednisolone mortality thrombocytopenia Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/9d1bfd2d1253447fb4124a2b3ac7d47e
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spelling	oai:doaj.org-article:9d1bfd2d1253447fb4124a2b3ac7d47e2021-11-16T07:16:03ZRisk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study2296-858X10.3389/fmed.2021.753659https://doaj.org/article/9d1bfd2d1253447fb4124a2b3ac7d47e2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.753659/fullhttps://doaj.org/toc/2296-858XBackground: Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs), but risk factors for COVID-19-associated IPA (CAPA) have not been fully characterized. The aim of the current study was to identify factors associated with CAPA, and assess long-term mortality.Methods: A retrospective cohort study of adult COVID-19 patients admitted to ICUs from six hospitals was conducted in Hubei, China. CAPA was diagnosed via composite clinical criteria. Demographic information, clinical variables, and 180-day outcomes after the diagnosis of CAPA were analyzed.Results: Of 335 critically ill patients with COVID-19, 78 (23.3%) developed CAPA within a median of 20.5 days (range 13.0–42.0 days) after symptom onset. Compared to those without CAPA, CAPA patients were more likely to have thrombocytopenia (50 vs. 19.5%, p < 0.001) and secondary bacterial infection prior to being diagnosed with CAPA (15.4 vs. 6.2%, p = 0.013), and to receive vasopressors (37.2 vs. 8.6%, p < 0.001), higher steroid dosages (53.9 vs. 34.2%, p = 0.002), renal replacement therapy (37.2 vs. 13.6%, p < 0.001), and invasive mechanical ventilation (57.7 vs. 35.8%, p < 0.001). In multivariate analysis incorporating hazard ratios (HRs) and confidence intervals (CIs), thrombocytopenia (HR 1.98, 95% CI 1.16–3.37, p = 0.012), vasopressor use (HR 3.57, 95% CI 1.80–7.06, p < 0.001), and methylprednisolone use at a daily dose ≥ 40 mg (HR 1.69, 95% CI 1.02–2.79, p = 1.02–2.79) before CAPA diagnosis were independently associated with CAPA. Patients with CAPA had longer median ICU stays (17 days vs. 12 days, p = 0.007), and higher 180-day mortality (65.4 vs. 33.5%, p < 0.001) than those without CAPA.Conclusions: Thrombocytopenia, vasopressor use, and corticosteroid treatment were significantly associated with increased risk of incident IPA in COVID-19 patients admitted to ICUs. The occurrence of CAPA may increase the likelihood of long-term COVID-19 mortality.Jiqian XuJiqian XuJiqian XuXiaobo YangZheng LvTing ZhouHong LiuHong LiuXiaojing ZouFengsheng CaoLu ZhangBoyi LiuWei ChenYuan YuHuaqing ShuShiying YuanMing HuChaolin HuangYou ShangYou ShangYou ShangFrontiers Media S.A.articleCOVID-19CAPAmethylprednisolonemortalitythrombocytopeniaMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 CAPA methylprednisolone mortality thrombocytopenia Medicine (General) R5-920
spellingShingle	COVID-19 CAPA methylprednisolone mortality thrombocytopenia Medicine (General) R5-920 Jiqian Xu Jiqian Xu Jiqian Xu Xiaobo Yang Zheng Lv Ting Zhou Hong Liu Hong Liu Xiaojing Zou Fengsheng Cao Lu Zhang Boyi Liu Wei Chen Yuan Yu Huaqing Shu Shiying Yuan Ming Hu Chaolin Huang You Shang You Shang You Shang Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study
description	Background: Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs), but risk factors for COVID-19-associated IPA (CAPA) have not been fully characterized. The aim of the current study was to identify factors associated with CAPA, and assess long-term mortality.Methods: A retrospective cohort study of adult COVID-19 patients admitted to ICUs from six hospitals was conducted in Hubei, China. CAPA was diagnosed via composite clinical criteria. Demographic information, clinical variables, and 180-day outcomes after the diagnosis of CAPA were analyzed.Results: Of 335 critically ill patients with COVID-19, 78 (23.3%) developed CAPA within a median of 20.5 days (range 13.0–42.0 days) after symptom onset. Compared to those without CAPA, CAPA patients were more likely to have thrombocytopenia (50 vs. 19.5%, p < 0.001) and secondary bacterial infection prior to being diagnosed with CAPA (15.4 vs. 6.2%, p = 0.013), and to receive vasopressors (37.2 vs. 8.6%, p < 0.001), higher steroid dosages (53.9 vs. 34.2%, p = 0.002), renal replacement therapy (37.2 vs. 13.6%, p < 0.001), and invasive mechanical ventilation (57.7 vs. 35.8%, p < 0.001). In multivariate analysis incorporating hazard ratios (HRs) and confidence intervals (CIs), thrombocytopenia (HR 1.98, 95% CI 1.16–3.37, p = 0.012), vasopressor use (HR 3.57, 95% CI 1.80–7.06, p < 0.001), and methylprednisolone use at a daily dose ≥ 40 mg (HR 1.69, 95% CI 1.02–2.79, p = 1.02–2.79) before CAPA diagnosis were independently associated with CAPA. Patients with CAPA had longer median ICU stays (17 days vs. 12 days, p = 0.007), and higher 180-day mortality (65.4 vs. 33.5%, p < 0.001) than those without CAPA.Conclusions: Thrombocytopenia, vasopressor use, and corticosteroid treatment were significantly associated with increased risk of incident IPA in COVID-19 patients admitted to ICUs. The occurrence of CAPA may increase the likelihood of long-term COVID-19 mortality.
format	article
author	Jiqian Xu Jiqian Xu Jiqian Xu Xiaobo Yang Zheng Lv Ting Zhou Hong Liu Hong Liu Xiaojing Zou Fengsheng Cao Lu Zhang Boyi Liu Wei Chen Yuan Yu Huaqing Shu Shiying Yuan Ming Hu Chaolin Huang You Shang You Shang You Shang
author_facet	Jiqian Xu Jiqian Xu Jiqian Xu Xiaobo Yang Zheng Lv Ting Zhou Hong Liu Hong Liu Xiaojing Zou Fengsheng Cao Lu Zhang Boyi Liu Wei Chen Yuan Yu Huaqing Shu Shiying Yuan Ming Hu Chaolin Huang You Shang You Shang You Shang
author_sort	Jiqian Xu
title	Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study
title_short	Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study
title_full	Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study
title_fullStr	Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study
title_full_unstemmed	Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study
title_sort	risk factors for invasive aspergillosis in patients admitted to the intensive care unit with coronavirus disease 2019: a multicenter retrospective study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/9d1bfd2d1253447fb4124a2b3ac7d47e
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Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study

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