TY - JOUR
T1 - Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy
AU - van Grootveld, Rebecca
AU - van der Beek, Martha T.
AU - the CAPA2.0 study group
AU - Janssen, Nico A.F.
AU - Ergün, Mehmet
AU - van Dijk, Karin
AU - Bethlehem, Carina
AU - Stads, Susanne
AU - van Paassen, Judith
AU - Heunks, Leo M.A.
AU - Bouman, Catherine S.C.
AU - Reijers, Monique H.E.
AU - Brüggeman, Roger J.
AU - van de Veerdonk, Frank L.
AU - van Bree, Sjoerd H.W.
AU - van den Berg, Charlotte H.S.B.
AU - Kuindersma, Marnix
AU - Wauters, Joost
AU - Beishuizen, Albertus
AU - Verweij, Paul E.
AU - Schouten, Jeroen A.
N1 - Funding
Funding was provided by the Dutch National Institute for Public Health and the Environment (RIVM) and the ZonMw COVID-19 Programme.
Publisher Copyright: © 2023 The Authors
PY - 2023/8
Y1 - 2023/8
N2 - Purpose: COVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment. Materials and methods: A retrospective, observational, multicentre study was performed from September 2020–April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria. Results: CAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy. Conclusions: CAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation.
AB - Purpose: COVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment. Materials and methods: A retrospective, observational, multicentre study was performed from September 2020–April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria. Results: CAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy. Conclusions: CAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation.
UR - http://www.scopus.com/inward/record.url?scp=85148731945&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2023.154272
DO - 10.1016/j.jcrc.2023.154272
M3 - Article
C2 - 36801598
AN - SCOPUS:85148731945
SN - 0883-9441
VL - 76
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154272
ER -