Mycoses. 2022 Feb 25. doi: 10.1111/myc.13434. Online ahead of print.
BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) is a major complication of critically ill COVID-19 patients, with a high mortality rate and potentially preventable. Thus, identifying patients at high risk of CAPA would be of great interest. We intended to develop a clinical prediction score capable of stratifying patients according to the risk for CAPA at ICU admission.
METHODS: Single center retrospective case-control study. A case was defined as a patient diagnosed with CAPA according to 2020 ECMM/ISHAM consensus criteria. 2 controls were selected for each case among critically ill COVID-19 patients.
RESULTS: 28 CAPA patients and 56 matched controls were included. Factors associated with CAPA included old age (68 years vs 62, p=0.033), active smoking (17.9% vs 1.8%, p=0.014), chronic respiratory diseases (48.1% vs 26.3%, p=0.043), chronic renal failure (25.0% vs 3.6%, p=0.005), chronic corticosteroid treatment (28.6% vs 1.8%, p<0.001), tocilizumab therapy (92.9% vs 66.1%, p=0.008) and high APACHE II at ICU admission (median 13 vs 10 points, p=0.026). A score was created including these variables, which showed an area under the receiver operator curve of 0.854 (95% CI 0.77-0.92). A punctuation below 6 had a negative predictive value of 99.6%. A punctuation of 10 or higher had a positive predictive value of 27.9%.
CONCLUSION: We present a clinical prediction score that allowed to stratify critically ill COVID-19 patients according to the risk for developing CAPA. This CAPA-score would allow to target preventive measures. Further evaluation of the score, as well as the utility of these targeted preventive measures, is needed.