KL-6 as a predictor of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) and mortality in critically ill COVID-19 patients: A single-center retrospective cohort study.

IF 2.7 3区 医学 Q3 INFECTIOUS DISEASES
Hyun Kyu Cho, Si-Ho Kim, Cheon-Hoo Jeon, Jae Wan Jung, Yu Mi Wi
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Abstract

This study evaluated the predictive value of Krebs von den Lungen-6 (KL-6) for the development of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) and its association with mortality in critically ill COVID-19 patients. A retrospective single-center cohort study was conducted on critically ill COVID-19 patients who required high-flow oxygen or mechanical ventilation between January 2021 and June 2023. Serial serum KL-6 levels were measured at admission and weekly thereafter. The predictive performance of initial KL-6 was assessed using ROC curve analysis, and risk factors for CAPA and 30-day mortality were analyzed using multivariable models. Among 238 patients, 25 (10.5%) developed CAPA. Initial KL-6 demonstrated good discriminative ability for CAPA prediction (AUC 0.745; 95% CI: 0.685-0.799), with an optimal cutoff of 270.9 U/ml (sensitivity: 88.0%, specificity: 55.4%). KL-6 ≥ 270.9 U/ml remained independently associated with CAPA (aHR: 9.66; 95% CI: 2.28-40.89) after multivariable analysis. Serial measurements showed a trend toward a greater increase in KL-6 levels among CAPA patients than non-CAPA patients (median difference: 259.9 vs. 73.0 U/ml, P = .053). Additional independent predictors of CAPA included inotropic/vasopressor support, diabetes mellitus, and tocilizumab use. CAPA patients had higher all-cause 30-day mortality (60.8% vs. 45.2%; P = .020), which remained significant after adjustment (aHR: 2.19; 95% CI: 1.08-4.15). Furthermore, KL-6 was independently associated with 30-day mortality (aHR: 1.03 per 100 U/ml; 95% CI: 1.00-1.07). These findings suggest that KL-6 is a promising biomarker for predicting CAPA and mortality in critically ill COVID-19 patients.

KL-6作为2019冠状病毒病(COVID-19)相关肺曲霉病(CAPA)和危重患者死亡率的预测因子:一项单中心回顾性队列研究
本研究评估了Krebs von den Lungen-6 (KL-6)对2019冠状病毒病(COVID-19)相关肺曲霉病(CAPA)发展的预测价值及其与COVID-19危重症患者死亡率的相关性。对2021年1月至2023年6月期间需要高流量供氧或机械通气的COVID-19危重症患者进行回顾性单中心队列研究。入院时和入院后每周连续测定血清KL-6水平。采用ROC曲线分析评估初始KL-6的预测性能,采用多变量模型分析CAPA和30天死亡率的危险因素。238例患者中有25例(10.5%)发生CAPA。初始KL-6具有较好的CAPA预测判别能力(AUC为0.745;95% CI: 0.685-0.799),最佳截止值为270.9 U/mL(灵敏度:88.0%,特异性:55.4%)。KL-6≥270.9 U/mL与CAPA独立相关(aHR: 9.66;95% CI: 2.28-40.89)。连续测量显示,CAPA患者的KL-6水平比非CAPA患者有更大的升高趋势(中位数差异:259.9比73.0 U/mL, P = 0.053)。CAPA的其他独立预测因素包括肌力/血管加压剂支持、糖尿病和托珠单抗使用。CAPA患者的全因30天死亡率更高(60.8% vs. 45.2%;P = 0.020),调整后仍有显著性差异(aHR: 2.19;95% ci: 1.08-4.15)。此外,KL-6与30天死亡率独立相关(aHR: 1.03 / 100 U/mL;95% ci: 1.00-1.07)。这些结果表明,KL-6是一种有希望预测COVID-19危重患者CAPA和死亡率的生物标志物。
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来源期刊
Medical mycology
Medical mycology 医学-兽医学
CiteScore
5.70
自引率
3.40%
发文量
632
审稿时长
12 months
期刊介绍: Medical Mycology is a peer-reviewed international journal that focuses on original and innovative basic and applied studies, as well as learned reviews on all aspects of medical, veterinary and environmental mycology as related to disease. The objective is to present the highest quality scientific reports from throughout the world on divergent topics. These topics include the phylogeny of fungal pathogens, epidemiology and public health mycology themes, new approaches in the diagnosis and treatment of mycoses including clinical trials and guidelines, pharmacology and antifungal susceptibilities, changes in taxonomy, description of new or unusual fungi associated with human or animal disease, immunology of fungal infections, vaccinology for prevention of fungal infections, pathogenesis and virulence, and the molecular biology of pathogenic fungi in vitro and in vivo, including genomics, transcriptomics, metabolomics, and proteomics. Case reports are no longer accepted. In addition, studies of natural products showing inhibitory activity against pathogenic fungi are not accepted without chemical characterization and identification of the compounds responsible for the inhibitory activity.
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