Effects of COVID-19-Associated Pulmonary Aspergillosis (CAPA) on the prognosis of severe COVID-19: Clinical characteristics and risk factors in a second-level hospital from Southern Spain

Introduction

SARS-CoV-2 infection patients face infectious complications, including fungal infections. COVID-19-Associated Pulmonary Aspergillosis (CAPA) is linked to SARS-CoV-2 damage, corticosteroids, and pulmonary diseases. Diagnostic uncertainties persist, and this study aims to contribute evidence on CAPA risk factors, diagnostics, and prognosis.

Methods

A retrospective case–control study focused on critically ill COVID-19 patients with CAPA between March 2020 and December 2022 in a second-level hospital. Variables included demographic and medical history, infection course, treatments, complications, and outcomes.

Results

27 CAPA cases and 56 controls were collected. CAPA prevalence was 5.1% considering adapted criteria. CAPA cases were associated with cardiovascular risk factors, autoimmune diseases, chronic corticosteroid therapy, and other immunosuppressants, RRT, ECMO, cumulative corticosteroid dose, direct ICU admission, and invasive mechanical ventilation. They exhibited higher RALE and APACHE-II scores, direct ICU admission, and more invasive ventilatory support. CAPA patients had a higher risk of mortality at 120 days. The CAPA score demonstrated sensitivity and specificity in predicting CAPA risk.

Conclusions

There is a high mortality rate at 120 days among cases (67%). Classical risk factors and other new ones, such as the use of ECMO, autoimmune diseases, or direct admission to the ICU, have been postulated. The accumulated dose of steroids (>800 mg of metilprednisolone) is one of the key risk factors in the development of CAPA. The CAPA score is a useful tool to define which patients should be monitored closely, although more studies are still needed.