COVID-19-associated pulmonary aspergillosis (CAPA) is burdened by high mortality. Data are lacking about non-ICU patients. Aims of this study were to: (i) assess the incidence and prevalence of CAPA ...in a respiratory sub-intensive care unit, (ii) evaluate its risk factors and (iii) impact on in-hospital mortality. Secondary aims were to: (i) assess factors associated to mortality, and (ii) evaluate significant features in hematological patients.
This was a single-center, retrospective study of COVID-19 patients with acute respiratory failure. A cohort of CAPA patients was compared to a non-CAPA cohort. Among patients with CAPA, a cohort of hematological patients was further compared to another of non-hematological patients.
Three hundred fifty patients were included in the study. Median P/F ratio at the admission to sub-intensive unit was 225 mmHg (IQR 155-314). 55 (15.7%) developed CAPA (incidence of 5.5%). Eighteen had probable CAPA (37.3%), 37 (67.3%) possible CAPA and none proven CAPA. Diagnosis of CAPA occurred at a median of 17 days (IQR 12-31) from SARS-CoV-2 infection. Independent risk factors for CAPA were hematological malignancy OR 1.74 (95%CI 0.75-4.37), p = 0.0003, lymphocytopenia OR 2.29 (95%CI 1.12-4.86), p = 0.02, and COPD OR 2.74 (95%CI 1.19-5.08), p = 0.014. Mortality rate was higher in CAPA cohort (61.8% vs 22.7%, p < 0.0001). CAPA resulted an independent risk factor for in-hospital mortality OR 2.92 (95%CI 1.47-5.89), p = 0.0024. Among CAPA patients, age > 65 years resulted a predictor of mortality OR 5.09 (95% CI 1.20-26.92), p = 0.035. No differences were observed in hematological cohort.
CAPA is a life-threatening condition with high mortality rates. It should be promptly suspected, especially in case of hematological malignancy, COPD and lymphocytopenia.
Long COVID is defined as persistency of symptoms, such as exertional dyspnea, twelve weeks after recovery from SARS-CoV-2 infection.
To investigate ventilatory efficiency by the use of ...cardiopulmonary exercise testing (CPET) in patients with exertional dyspnea despite normal basal spirometry after 18 (T18) and 36 months (T36) from COVID-19 pneumonia.
One hundred patients with moderate-critical COVID-19 were prospectively enrolled in our Long COVID program. Medical history, physical examination and lung high-resolution computed tomography (HRCT) were obtained at hospitalization (T0), 3 (T3) and 15 months (T15). All HRCTs were revised using a semi-quantitative CT severity score (CSS). Pulmonary function tests were obtained at T3 and T15. CPET was performed in a subset of patients with residual dyspnea (mMRC ≥ 1), at T18 and at T36.
Remarkably, at CPET, ventilatory efficiency was reduced both at T18 (V’E/V’CO2 slope = 31.4±3.9 SD) and T36 (V’E/V’CO2 slope = 31.28±3.70 SD). Furthermore, we identified positive correlations between V’E/V’CO2 slope at T18 and T36 and both percentage of involvement and CSS at HRCT at T0, T3 and T15. Also, negative linear correlations were found between V’E/V’CO2 slope at T18 and T36 and DLCO at T3 and T15.
At eighteen months from COVID-19 pneumonia, 20 % of subjects still complains of exertional dyspnea. At CPET this may be explained by persistently reduced ventilatory efficiency, possibly related to the degree of lung parenchymal involvement in the acute phase of infection, likely reflecting a damage in the pulmonary circulation.
•Exertional dyspnea persists in 20 % of patients that have suffered moderate to severe COVID19 Pneumonia.•At CPET, reduced ventilatory efficiency is observed at 18 and 36 months follow-up in patients with exertional dyspnea and normal spirometry.•Data on its pathophysiology is limited, and different mechanisms could explain this invalidating symptom. In our study, the finding of high V’E/V’CO2 slope at 18 and 36 months follow-up, and its correlation with the severity of pneumonia at lung HRCT and with the reduction of DLCO, could identify a possible contributing factor for the persistency of exertional dyspnea in these patients, leading to the hypothesis of a link between the initial extension of pneumonia, pulmonary vascular damage and persistency of ventilatory inefficiency at long-term follow-up.
Patients with haematological malignancies (HM) and SARS-CoV-2 infection present a higher risk of severe COVID-19 and mortality. The aim of the study was to investigate whether vaccination and ...monoclonal antibodies (mAbs) have modified the outcomes of HM patients with COVID-19. This is a single-centre retrospective study in HM patients hospitalized due to SARS-CoV-2 infection from March 2020 to April 2022. Patients were divided into PRE-V-mAb group (patients hospitalized before the introduction of vaccination and mAbs) and POST-V-mAb group (patients hospitalized after the use of vaccine and mAbs). A total of 126 patients were included (65 PRE-V-mAb and 61 POST-V-mAb). POST-V-mAb patients showed a significantly lower risk of intensive care unit (ICU) admission (8.2% vs. 27.7%,
p
= 0.005), shorter viral shedding 17 (IQR 10–28) vs. 24 days (IQR 15–50),
p
= 0.011 and shorter hospitalization length 13 (IQR 7–23) vs. 20 (IQR 14–41) days,
p
= 0.0003 compared to the PRE-V-mAb group. Nevertheless, both in-hospital and 30-day mortality rates did not significantly differ between the two groups (29.5% POST-V-mAb vs. 36.9% PRE-V-mAb and 21.3% POST-V-mAb vs. 29.2% PRE-V-mAb, respectively). At the multivariable analysis, an active malignancy (
p
= 0.042), a critical COVID-19 at admission (
p
= 0.025) and the need for high-level of oxygen support at respiratory worsening either HFNC/CPAP (
p
= 0.022) or mechanical ventilation (
p
= 0.011) were independently associated with in-hospital mortality. In the subgroup of POST-V-mAb patients, receiving therapy with mAbs was a protective factor (
p
= 0.033). Despite the new therapeutic and preventive strategies available, HM patients with COVID-19 disease represent an extremely vulnerable group with still high mortality rates.
