Comparison of risk factors and outcome of patients with and without COVID‐19‐associated pulmonary aspergillosis from Pakistan: A case–control study

Abstract

Background Early identification of COVID‐19‐associated pulmonary aspergillosis (CAPA) is particularly challenging in low‐ middle‐income countries where diagnostic capabilities are limited, and risk factors for CAPA have not been identified. It is also essential to recognise CAPA patients who are likely to have a poorer outcome to decide on aggressive management approaches. Therefore, this study aimed to identify risk factors and outcomes for CAPA among admitted moderate to critical COVID‐19 patients at our centre in Pakistan. Methods An unmatched case–control study with ratio of 1:2 was conducted on hospitalised adult patients with COVID‐19 from March 2020–July 2021. Cases were defined according to European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus criteria. Controls were defined as patients hospitalised with moderate, severe or critical COVID‐19 without CAPA. Results A total of 100 CAPA cases (27 probable CAPA; 73 possible CAPA) were compared with 237 controls. Critical disease at presentation (aOR 5.04; 95% CI 2.18–11.63), age ≥ 60 years (aOR 2.00; 95% CI 1.20–3.35) and underlying co‐morbid of chronic kidney disease (CKD) (aOR 3.78; 95% CI 1.57–9.08) were identified as risk factors for CAPA. Patients with CAPA had a significantly greater proportion of complications and longer length of hospital stay ( p ‐value < .001). Mortality was higher in patients with CAPA (48%) as compared to those without CAPA (13.5%) [OR = 6.36(95% CI 3.6–11)]. Conclusions CAPA was significantly associated with advanced age, CKD and critical illness at presentation, along with a greater frequency of complications and higher mortality.

Incidence and Mortality of COVID-19-Associated Invasive Fungal Infections Among Critically Ill Intubated Patients: A Multicenter Retrospective Cohort Analysis

“…Permpalung et al found no difference in intensive care unit (ICU) mortality among 39 patients [ 6 ]. A larger cohort identified an association but was limited by unspecified follow-up and single-center design [ 35 ]. An analysis in 20 centers showed higher 90-day ICU mortality in 109 aspergillosis patients and adjusted for immortal time bias [ 9 ].…”

A Hybrid Modeling Framework for Generalizable and Interpretable Predictions of ICU Mortality: Leveraging ICD Codes in a Multi-Hospital Study of Mechanically Ventilated Influenza Patients

“…• Infectious and bacterial diseases module: This module connects several factors that have a high impact on mortality prediction, including "Diseases of liver", "Other bacterial diseases", "Diseases of the genitourinary system", and "Mycoses". Patients in the ICU are often susceptible to infections, which can worsen their clinical outcomes [51][52][53] ; interactions with liver diseases, which are known to be correlated with mortality themselves 54,55 , have also been reported…”

Prevalence of co‐existent COVID‐19‐associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID‐19‐associated pulmonary mucormycosis (CAPM)

“…Invasive pulmonary aspergillosis and pulmonary mucormycosis are the most common mould infections and share common risk factors and clinical‐radiological presentation. Besides neutropenia, organ transplantation and haematological malignancies, poorly controlled diabetes mellitus is an important predisposing factor for invasive mould infection in developing countries 1,2 . Both pulmonary mucormycosis and aspergillosis cases significantly increased following the COVID‐19 pandemic in India, especially in those with additional predisposing factors 3–5 .…”