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Iacovelli, Alessandra; Oliva, Alessandra; Mirabelli, Flavio Marco; Giannone, Silvia; Laguardia, Marianna; Morviducci, Matteo; Nicolardi, Maria Luisa; Repaci, Emma; Sanzari, Maria Teresa; Leanza, Cristiana; Raponi, Giammarco; Mastroianni, Claudio; Palange, Paolo
BMC infectious diseases, 04/2024, Letnik: 24, Številka: 1Journal Article
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.
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in: SICRIS
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