COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants

Bay, Pierre; Audureau, Etienne; Préau, Sébastien; Favory, Raphaël; Guigon, Aurélie; Heming, Nicholas; Gault, Elyanne; Pham, Tài; Chaghouri, Amal; Turpin, Matthieu; Morand-Joubert, Laurence; Jochmans, Sébastien; Pitsch, Aurélia; Meireles, Sylvie; Contou, Damien; Henry, Amandine; Joseph, Adrien; Chaix, Marie-Laure; Uhel, Fabrice; Roux, Damien; Descamps, Diane; Emery, Malo; Garcia-Sanchez, Claudio; Levy, David; Burrel, Sonia; Mayaux, Julien; Kimmoun, Antoine; Hartard, Cédric; Pène, Frédéric; Rozenberg, Flore; Gaudry, Stéphane; Brichler, Ségolène; Guillon, Antoine; Handala, Lynda; Tamion, Fabienne; Moisan, Alice; Daix, Thomas; Hantz, Sébastien; Delamaire, Flora; Thibault, Vincent; Souweine, Bertrand; Henquell, Cecile; Picard, Lucile; Botterel, Françoise; Rodriguez, Christophe; Dessap, Armand Mekontso; Pawlotsky, Jean-Michel; Fourati, Slim; de Prost, Nicolas

doi:10.1186/s13613-024-01296-0

Annals of Intensive Care

Table 1 Characteristics of critically ill COVID-19 patients (n = 566) at intensive care unit admission according to Coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA) status

From: COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants

Variable	n/n^a	All patients, n = 566	Non-CAPA patients, n = 537	CAPA patients, n = 29	p
Demographics and comorbidities
Sex, females		191 (34)	183 (34)	5 (28)	0.5
Age, years		66 [57–74]	66 [57–74]	67 [60–70]	0.7
Diabetes		179 (33)	168 (33)	11 (39)	0.5
Obesity^b		183 (33)	172 (32)	11 (38)	0.5
Chronic heart failure		52 (10)	52 (10)	0	0.1
Hypertension		281 (52)	266 (52)	15 (54)	0.8
Chronic respiratory failure		78 (14)	75 (15)	3 (11)	0.8
Chronic renal failure		113 (21)	107 (21)	6 (21)	0.9
Cirrhosis		8 (1)	7 (1)	1 (4)	0.3
Immunosuppression		189 (35)	174 (34)	15 (54)	0.03
None		357 (65)	344 (66)	13 (46)	0.09
Solid organ transplant		67 (12)	63 (12)	4 (14)
Onco-hematological malignancies		59 (11)	54 (10)	5 (18)
Others^c		62 (11)	56 (11)	6 (21)
Number of comorbidities	518/28	2 [1–3]	2 [1–3]	2 [1–4]	0.5
Clinical frailty scale	528/29	3 [2–4]	3 [2–4]	3 [2–4]	0.9
SARS-CoV-2 infection and vaccination
Previous SARS-CoV-2 infection	506/28	40 (7)	39 (8)	1 (4)	0.8
SARS-CoV-2 vaccination		326 (59)	306 (59)	20 (69)	0.3
SARS-CoV-2 serology at ICU admission
Unavailable		279 (49)	271 (50)	8 (28)	0.04
Negative^d		129 (23)	119 (22)	10 (34)
Positive		158 (28)	147 (27)	11 (38)
First symptoms-ICU admission, days	535/29	7 [3–10]	7 [3–10]	8 [6–11]	0.03
SARS-CoV-2 RNA detection in nasopharyngeal swabs, Ct	359/17	21 [18–25]	21 [18–25]	23 [20–26]	0.2
SARS-CoV-2 variant	387/24
Omicron		313 (76.2)	298 (77)	15 (62.5)	0.1
Delta		98 (23.8)	89 (23)	9 (37.5)
Patients severity upon ICU admission and biological features
WHO 10-point scale	353/29	6 [6–6]	6 [6–6]	6 [6–8]	0.09
SAPS II score	486/28	35 [27–45]	35 [27–44]	39 [26–53]	0.1
SOFA score	505/28	4 [3–6]	4 [3–6]	4 [3–8]	0.3
PaO2/FiO2 ratio, mmHg	520/28	124 [79–188]	124 [79–190]	127 [76–170]	0.5
Arterial lactate level, mM	506/27	1.5 [1–2.2]	1.5 [1–2.3]	1.9 [1.1–2.2]	0.6
Blood leukocytes, G/L	529/29	8.9 [5.6–13]	8.9 [5.7–13]	3.9 [6.5–12.4]	0.2
Blood lymphocytes, G/L	434/26	0.5 [0.3–0.9]	0.5 [0.3–0.9]	0.4 [0.5–0.9]	0.9
Blood platelets, G/L	529/29	206 [146–298]	207 [148–289]	191 [107–315]	0.5
Serum urea level, mM	523/29	8 [6–15]	5 [5–14]	12 [7–18]	0.06
Serum creatinine level, µM	532/29	89 [63–141]	89 [62–138]	97 [73–235]	0.1
Lung parenchyma involvement, %	274/18	50 [37–75]	50 [37–75]	50 [40–70]	1
Oxygen/ventilatory support					0.2
Oxygen		100 (18)	97 (18)	3 (10)
High flow oxygen		269 (48)	255 (48)	14 (48)
NIV/C-PAP		58 (10)	57 (11)	1 (3)
Invasive MV		135 (24)	124 (23)	11 (38)
ECMO		15 (3)	15 (3)	0	1
Vasopressor support		86 (15)	82 (16)	4 (14)	0.8

Results are N (%), means (± standard deviation) or medians (interquartile range, i.e., quartile 1; quartile 3)
CAPA COVID-19-associated pulmonary aspergillosis, ICU intensive care unit, Ct cycle threshold, WHO World Health Organization, SOFA Sequential Organ Failure Assessment, SAPS II Simplified Acute Physiology Score II, NIV non-invasive ventilation, C-PAP continuous-positive airway pressure, MV mechanical ventilation, ECMO extracorporeal mechanical ventilation
^aNumbers of non-CAPA/CAPA patients data available
^bDefined as a body mass index ≥ 30 kg/m²
^cIncludes HIV infection, long-term corticosteroid treatment, and other immunosuppressive treatments
^dDefined as < 30 Binding Antibody Units (BAU)/mL
Two-tailed p-values come from unadjusted comparisons using Chi-square or Fisher’s exact tests for categorical variables, and t-tests or Mann–Whitney tests for continuous variables, as appropriate. No adjustment for multiple comparisons was performed. Bolded p-values are significant at the p < 0.05 level

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