Clinical Characteristics, Prognosis, and Risk Factors for Mortality in Influenza-Associated Pulmonary Aspergillosis and COVID-19-Associated Pulmonary Aspergillosis: A Multicenter Retrospective Study.

Abstract

Objective: Multiple studies have confirmed that viral pneumonia is a high-risk factor for invasive pulmonary aspergillosis (IPA), this retrospective study aims to analyze the differences in clinical characteristics, prognosis, and high-risk factors for mortality between patients with influenza virus-associated pulmonary aspergillosis (IAPA) and those with COVID-19-associated pulmonary aspergillosis (CAPA).

Methods: Clinical data from IAPA and CAPA patients diagnosed at four hospitals were collected. The clinical characteristics and prognostic differences between the two groups were analyzed and compared, with Cox regression used to identify the risk factors for mortality.

Results: A total of 106 patients were included in this study. Compared to CAPA patients, IAPA patients had a higher proportion of chronic obstructive pulmonary disease comorbidities, lower rates of history of solid organ transplantation, and a shorter time from viral infection to aspergillosis development. CAPA patients exhibited lower levels of white blood cells, and C-reactive protein. The CAPA group also received longer courses of antibiotic and corticosteroid therapy. Compared to IAPA, the CAPA group exhibited a higher incidence of complications, including bacterial infections, deep vein thrombosis in the lower limbs, gastrointestinal bleeding, and heart failure. The mortality rate was also higher in the CAPA group. The survival curve of IAPA was more favorable than that of CAPA. Cox regression analysis identified ICU admission at diagnosis as an independent risk factor for mortality in IAPA patients (OR= 9.578).

Conclusion: The IAPA group had a higher proportion of patients with COPD, a more acute disease onset, Admission to the ICU at diagnosis was identified as a risk factor for IAPA-related mortality. In comparison, the CAPA group had a higher proportion of immunodeficient patients, received more corticosteroid treatment, and was more susceptible to complications such as bacterial infections, thrombosis, and gastrointestinal bleeding, all of which contributed to an increased risk of death.