Mortality in critically ill patients with coronavirus disease 2019‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Abstract

Reports of COVID‐19 associated pulmonary aspergillosis (CAPA) are rising, but the associated mortality and factors affecting it are not well‐characterised. We performed a systematic review including 20 peer‐reviewed English language studies reporting mortality in CAPA published till 18 February 2021from PubMed, Ovid SP, Web of Science, Embase and CINHAL. The pooled mortality in CAPA was 51.2% (95% CI: 43.1–61.1, I2 = 38%). The leave one out sensitivity analysis and influential case diagnostics revealed one outlier and its exclusion resulted in a mortality estimate of 54% (95% CI: 45–62). Higher odds of mortality: 2.83 (95% CI: 1.8–4.5) were seen in CAPA compared to controls. No significant difference in various subgroups according to the country of study, the continent of study, income category of country and quality of the included study was seen. None of the host risk factors, mycological test results, therapy for COVID‐19 and antifungal therapy affected mortality. Thus, patients with CAPA have a high probability of mortality and early diagnosis with prompt therapy must be ensured to optimally manage these patients. However, more prospective studies with global and multi‐centre coordination may help to address CAPA in a better way.

Incidence and Risk Factors of COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit—A Monocentric Retrospective Observational Study

“…Recent systematic reviews and a meta-analysis of CAPA reported an overall mortality rate of 51.2% [28], 52.2% [7] and 54.9% [36]. The prospective studies of Bartoletti et al and White et al reported the mortality rates of 44% vs. 19% [24] and 58% vs. 31% [25] 30 days after ICU admission, in the CAPA group compared to the non-CAPA control group, respectively.…”

“…Similarly, in their recent meta-analysis, Singh et al reported an overall mortality rate in CAPA patients of 52.2% [28]. However, unlike Pasquier et al, their meta-regression analysis did not reveal any association between mortality in CAPA and any risk factor, COVID-19specific therapy or anti-fungal therapy [28].…”

“…High age and pulmonary disease are also risk factors of mortality in the general COVID-19 population, but elevated serum GM might reflect a real influence of CAPA on mortality [27]. Similarly, in their recent meta-analysis, Singh et al reported an overall mortality rate in CAPA patients of 52.2% [28]. However, unlike Pasquier et al, their meta-regression analysis did not reveal any association between mortality in CAPA and any risk factor, COVID-19specific therapy or anti-fungal therapy [28].…”

Severe acute respiratory syndrome coronavirus 2 infection in the stem cell transplant recipient − clinical spectrum and outcome

“…Some studies have observed higher serum procalcitonin levels in recipients with co-infection as compared to those free from this complication [ 17 ▪ ]. The diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA) has been only occasionally reported [ 15 , 17 ▪ , 25 , 26 ], and HSCT recipients are marginally represented in case series of CAPA [ 27 , 28 ]. There have been also an anecdotal report of an aseptic meningitis with negative reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 in the cerebrospinal fluid after initial clinical recovery from COVID-19, suggesting a potential pathogenic role for molecular mimicry [ 29 ].…”

Invasive Pulmonary Aspergillosis and Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis - Sequelae of COVID-19 in a Liver Transplant Recipient

“…Liver transplant recipients are associated with adverse outcomes after infection with coronavirus disease of 2019 (COVID-19) 1 . Use of high dose immunosuppression has also led to a rise in cases of invasive aspergillosis worldwide 2 . We describe a case highlighting the role of post-transplant immunosuppression and COVID-19 in causing reactivation of tuberculosis and invasive pulmonary aspergillosis, complicated by acquired Hemophagocytic Lymphohistiocytosis (HLH).…”