Prognostic Impact of Bronchoalveolar Lavage Fluid Galactomannan and Aspergillus Culture Results on Survival in COVID-19 Intensive Care Unit Patients: a Post Hoc Analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-Associated Pulmonary Aspergillosis Study

被引：23

作者：

Giacobbe, Daniele Roberto ^{[1
,2
]}

Prattes, Juergen ^{[3
]}

Wauters, Joost ^{[4
]}

Dettori, Silvia ^{[1
,2
]}

Signori, Alessio ^{[5
]}

Salmanton-Garcia, Jon ^{[6
,7
,8
]}

Maertens, Johan ^{[4
]}

Bourgeois, Marc ^{[9
]}

Reynders, Marijke ^{[9
]}

Rutsaert, Lynn ^{[10
]}

Van Regenmortel, Niels ^{[10
]}

Lormans, Piet ^{[11
]}

Feys, Simon ^{[4
]}

Klimko, Nikolay ^{[12
]}

Shadrivova, Olga ^{[12
]}

Cornely, Oliver A. ^{[6
,7
,13
,14
,15
]}

Rautemaa-Richardson, Riina ^{[16
,17
,18
]}

Koehler, Philipp ^{[6
,7
,8
]}

Lagrou, Katrien ^{[19
,20
]}

Bassetti, Matteo ^{[1
,2
]}

Hoenigl, Martin ^{[3
,21
,22
]}

机构：

[1] Univ Genoa, Dept Hlth Sci DISSAL, Genoa, Italy

[2] IRCCS Osped Policlin San Martino, Clin Malattie Infett, Genoa, Italy

[3] Med Univ Graz, Excellence Ctr Med Mycol ECMM, Div Infect Dis, Graz, Austria

[4] Univ Ziekenhuis Leuven, Leuven, Belgium

[5] Univ Genoa, Dept Hlth Sci DISSAL, Sect Biostat, Genoa, Italy

[6] Univ Cologne, Fac Med, Cologne, Germany

[7] Univ Hosp Cologne, Dept Internal Med, Excellence Ctr Med Mycol ECMM, Cologne, Germany

[8] Univ Hosp Cologne, Cologne Excellence Cluster Cellular Stress Respon, Cologne, Germany

[9] Algemeen Ziekenhuis Sint Jan Brugge Oostende, Brugge, Belgium

[10] Ziekenhusnetwerk Antwerp, Antwerp, Belgium

[11] Algemeen Ziekenhuis Delta, Roeselare, Belgium

[12] II Mechnikov Northwestern State Med Univ, St Petersburg, Russia

[13] Univ Hosp Cologne, Chair Translat Res, Cologne Excellence Cluster Cellular Stress Respon, Cologne, Germany

[14] Univ Hosp Cologne, Clin Trials Ctr Cologne, ZKS Koln, Cologne, Germany

[15] German Ctr Infect Res, DZIF, Partner Site Bonn, Cologne, Germany

[16] Manchester Univ NHS Fdn Trust, Wythenshawe Hosp, Mycol Reference Centre Manchester, Manchester, England

[17] Manchester Univ NHS Fdn Trust, Wythenshawe Hosp, Dept Infect Dis, Manchester, England

[18] Univ Manchester, Fac Biol Med & Hlth, Div Evolut Infect & Genom, Manchester, England

[19] Univ Hosp Leuven, Dept Lab Med, Leuven, Belgium

[20] Katholieke Univ Leuven, Dept Microbiol Immunol & Transplantat, Leuven, Belgium

[21] Univ Calif San Diego, Div Infect Dis & Global Publ Hlth, San Diego, CA USA

[22] Univ Calif San Diego, Clin & Translat Fungal Working Grp, San Diego, CA USA

来源：

JOURNAL OF CLINICAL MICROBIOLOGY | 2022年 / 60卷 / 04期

关键词：

CAPA; GM; biomarker; galactomannan; Aspergillus; COVID-19; BALF;

D O I：

10.1128/jcm.02298-21

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), which impacts their chances of survival. Whether positive bronchoalveolar lavage fluid (BALF) mycological tests can be used as a survival proxy remains unknown. We conducted a post hoc analysis of a previous multicenter, multinational observational study with the aim of assessing the differential prognostic impact of BALF mycological tests, namely, positive (optical density index of >= 1.0) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination for critically ill patients with COVID-19. Of the 592 critically ill patients with COVID-19 enrolled in the main study, 218 were included in this post hoc analysis, as they had both test results available. CAPA was diagnosed in 56/218 patients (26%). Most cases were probable CAPA (51/56 [91%]) and fewer were proven CAPA (5/56 [9%]). In the final multivariable model adjusted for between-center heterogeneity, an independent association with 90-day mortality was observed for the combination of positive BALF GM and positive BALF Aspergillus culture in comparison with both tests negative (hazard ratio, 2.53; 95% CI confidence interval [CI], 1.28 to 5.02; P = 0.008). The other independent predictors of 90-day mortality were increasing age and active malignant disease. In conclusion, the combination of positive BALF GM and positive BALF Aspergillus culture was associated with increased 90-day mortality in critically ill patients with COVID-19. Additional study is needed to explore the possible prognostic value of other BALF markers. Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), which impacts their chances of survival. Whether positive bronchoalveolar lavage fluid (BALF) mycological tests can be used as a survival proxy remains unknown.

引用

页数：9

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