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Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients

The literature regarding COVID-19-associated pulmonary aspergillosis (CAPA) has shown conflicting observations, including survival of CAPA patients not receiving antifungal therapy and discrepancy between CAPA diagnosis and autopsy findings. To gain insight into the pathophysiology of CAPA, we perfo...

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Autores principales: Ergün, Mehmet, Brüggemann, Roger J. M., Alanio, Alexandre, Dellière, Sarah, van Arkel, Andreas, Bentvelsen, Robbert G., Rijpstra, Tom, van der Sar-van der Brugge, Simone, Lagrou, Katrien, Janssen, Nico A. F., Buil, Jochem B., van Dijk, Karin, Melchers, Willem J. G., Reijers, Monique H. E., Schouten, Jeroen A., Wauters, Joost, Cordey, Alan, Soni, Shuchita, White, P. Lewis, van de Veerdonk, Frank L., Verweij, Paul E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society for Microbiology 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601217/
https://www.ncbi.nlm.nih.gov/pubmed/34495710
http://dx.doi.org/10.1128/JCM.01229-21
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author Ergün, Mehmet
Brüggemann, Roger J. M.
Alanio, Alexandre
Dellière, Sarah
van Arkel, Andreas
Bentvelsen, Robbert G.
Rijpstra, Tom
van der Sar-van der Brugge, Simone
Lagrou, Katrien
Janssen, Nico A. F.
Buil, Jochem B.
van Dijk, Karin
Melchers, Willem J. G.
Reijers, Monique H. E.
Schouten, Jeroen A.
Wauters, Joost
Cordey, Alan
Soni, Shuchita
White, P. Lewis
van de Veerdonk, Frank L.
Verweij, Paul E.
author_facet Ergün, Mehmet
Brüggemann, Roger J. M.
Alanio, Alexandre
Dellière, Sarah
van Arkel, Andreas
Bentvelsen, Robbert G.
Rijpstra, Tom
van der Sar-van der Brugge, Simone
Lagrou, Katrien
Janssen, Nico A. F.
Buil, Jochem B.
van Dijk, Karin
Melchers, Willem J. G.
Reijers, Monique H. E.
Schouten, Jeroen A.
Wauters, Joost
Cordey, Alan
Soni, Shuchita
White, P. Lewis
van de Veerdonk, Frank L.
Verweij, Paul E.
author_sort Ergün, Mehmet
collection PubMed
description The literature regarding COVID-19-associated pulmonary aspergillosis (CAPA) has shown conflicting observations, including survival of CAPA patients not receiving antifungal therapy and discrepancy between CAPA diagnosis and autopsy findings. To gain insight into the pathophysiology of CAPA, we performed a case-control study in which we compared Aspergillus test profiles in CAPA patients and controls in relation to intensive care unit (ICU) mortality. This was a multinational case-control study in which Aspergillus test results, use of antifungal therapy, and mortality were collected from critically ill COVID-19 patients. Patients were classified using the 2020 European Confederation for Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus case definitions. We analyzed 219 critically ill COVID-19 cases, including 1 proven, 38 probable, 19 possible CAPA cases, 21 Aspergillus-colonized patients, 7 patients only positive for serum (1,3)-β-d-glucan (BDG), and 133 cases with no evidence of CAPA. Mortality was 53.8% in CAPA patients compared to 24.1% in patients without CAPA (P = 0.001). Positive serum galactomannan (GM) and BDG were associated with increased mortality compared to serum biomarker-negative CAPA patients (87.5% versus 41.7%, P = 0.046; 90.0% versus 42.1%, P = 0.029, respectively). For each point increase in GM or 10-point BDG serum concentration, the odds of death increased (GM, odds ratio [OR] 10.208, 95% confidence interval [CI], 1.621 to 64.291, P = 0.013; BDG, OR, 1.247, 95% CI, 1.029 to 1.511, P = 0.024). CAPA is a complex disease, probably involving a continuum of respiratory colonization, tissue invasion, and angioinvasion. Serum biomarkers are useful for staging CAPA disease progression and, if positive, indicate angioinvasion and a high probability of mortality. There is need for a biomarker that distinguishes between respiratory tract colonization and tissue-invasive CAPA disease.
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spelling pubmed-86012172021-12-07 Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients Ergün, Mehmet Brüggemann, Roger J. M. Alanio, Alexandre Dellière, Sarah van Arkel, Andreas Bentvelsen, Robbert G. Rijpstra, Tom van der Sar-van der Brugge, Simone Lagrou, Katrien Janssen, Nico A. F. Buil, Jochem B. van Dijk, Karin Melchers, Willem J. G. Reijers, Monique H. E. Schouten, Jeroen A. Wauters, Joost Cordey, Alan Soni, Shuchita White, P. Lewis van de Veerdonk, Frank L. Verweij, Paul E. J Clin Microbiol Mycology The literature regarding COVID-19-associated pulmonary aspergillosis (CAPA) has shown conflicting observations, including survival of CAPA patients not receiving antifungal therapy and discrepancy between CAPA diagnosis and autopsy findings. To gain insight into the pathophysiology of CAPA, we performed a case-control study in which we compared Aspergillus test profiles in CAPA patients and controls in relation to intensive care unit (ICU) mortality. This was a multinational case-control study in which Aspergillus test results, use of antifungal therapy, and mortality were collected from critically ill COVID-19 patients. Patients were classified using the 2020 European Confederation for Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus case definitions. We analyzed 219 critically ill COVID-19 cases, including 1 proven, 38 probable, 19 possible CAPA cases, 21 Aspergillus-colonized patients, 7 patients only positive for serum (1,3)-β-d-glucan (BDG), and 133 cases with no evidence of CAPA. Mortality was 53.8% in CAPA patients compared to 24.1% in patients without CAPA (P = 0.001). Positive serum galactomannan (GM) and BDG were associated with increased mortality compared to serum biomarker-negative CAPA patients (87.5% versus 41.7%, P = 0.046; 90.0% versus 42.1%, P = 0.029, respectively). For each point increase in GM or 10-point BDG serum concentration, the odds of death increased (GM, odds ratio [OR] 10.208, 95% confidence interval [CI], 1.621 to 64.291, P = 0.013; BDG, OR, 1.247, 95% CI, 1.029 to 1.511, P = 0.024). CAPA is a complex disease, probably involving a continuum of respiratory colonization, tissue invasion, and angioinvasion. Serum biomarkers are useful for staging CAPA disease progression and, if positive, indicate angioinvasion and a high probability of mortality. There is need for a biomarker that distinguishes between respiratory tract colonization and tissue-invasive CAPA disease. American Society for Microbiology 2021-11-18 /pmc/articles/PMC8601217/ /pubmed/34495710 http://dx.doi.org/10.1128/JCM.01229-21 Text en Copyright © 2021 American Society for Microbiology. https://doi.org/10.1128/ASMCopyrightv2All Rights Reserved (https://doi.org/10.1128/ASMCopyrightv2) . https://doi.org/10.1128/ASMCopyrightv2This article is made available via the PMC Open Access Subset for unrestricted noncommercial re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Mycology
Ergün, Mehmet
Brüggemann, Roger J. M.
Alanio, Alexandre
Dellière, Sarah
van Arkel, Andreas
Bentvelsen, Robbert G.
Rijpstra, Tom
van der Sar-van der Brugge, Simone
Lagrou, Katrien
Janssen, Nico A. F.
Buil, Jochem B.
van Dijk, Karin
Melchers, Willem J. G.
Reijers, Monique H. E.
Schouten, Jeroen A.
Wauters, Joost
Cordey, Alan
Soni, Shuchita
White, P. Lewis
van de Veerdonk, Frank L.
Verweij, Paul E.
Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients
title Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients
title_full Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients
title_fullStr Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients
title_full_unstemmed Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients
title_short Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients
title_sort aspergillus test profiles and mortality in critically ill covid-19 patients
topic Mycology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601217/
https://www.ncbi.nlm.nih.gov/pubmed/34495710
http://dx.doi.org/10.1128/JCM.01229-21
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