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 - on behalf of 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 Information: ICUs in the Netherlands were invited to take part in this retrospective study via a newsletter issued regularly during the COVID-19 pandemic by the Dutch Intensive Care Society (NVIC). Centres that expressed interest were invited to participate and received financial support for data collection. One large Belgian centre was invited to take part as well. Funding was provided by the Dutch National Institute for Public Health and the Environment (RIVM) and the ZonMw COVID-19 Programme. Funding Information: We would like to thank everyone who contributed to this paper. In particular we want to thank the CAPA 2.0 study group, Cato Jacobs, Simon Feys, Yves Debaveye, Michiel van Lookeren Campagne, Max Melchers, Hetty Kranen, Willem Dieperink, Jantine van Holten, Renée van Ditshuizen, Jelle Goeman and the LUMC CAPA study group. Publisher Copyright: © 2023 The Authors
PY - 2023/8/1
Y1 - 2023/8/1
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.
KW - Aspergillus fumigatus
KW - CAPA
KW - COVID-19
KW - Intensive care unit
KW - Invasive fungal infections
KW - Invasive pulmonary aspergillosis
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85148731945&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2023.154272
DO - https://doi.org/10.1016/j.jcrc.2023.154272
M3 - Article
C2 - 36801598
SN - 0883-9441
VL - 76
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154272
ER -