Risk factors for COVID-19 associated pulmonary aspergillosis and outcomes in a respiratory sub-intensive care unit

<bold>Background:</bold> COVID-19-associated pulmonary aspergillosis (CAPA) is burdened by high mortality. Data are lacking about non-ICU patients. Aims of this study were to: (i) assess the incidence and prevalence of CAPA in a respiratory sub-intensive care unit, (ii) evaluate its risk factors and (iii) its impact on in-hospital mortality. Secondary aims were to: (i) assess factors associated to mortality, and (ii) evaluate significant features in hematological patients. <bold>Methods:</bold> Single-center, retrospective study of COVID-19 patients with severe respiratory failure. A cohort of CAPA patients was compared to a non-CAPA cohort. Among patients with CAPA, a cohort of hematological patients was further compared to another of non-hematological patients. <bold>Results:</bold> 350 patients were included in the study, 55 (15.7%) developed CAPA. 18 had probable CAPA (37.3%), 37 (67.3%) possible CAPA and none proven CAPA. Diagnosis occurred at a median of 17 days (IQR 12-31) from SARS-CoV-2 infection. Independent risk factors for CAPA were hematological malignancy [OR 1.74 (95%CI 0.75-4.37), p=0.0003], lymphocytopenia [OR 2.29 (95%CI 1.12-4.86), p=0.02], and COPD [OR 2,74 (95%CI 1.19-5.08), p=0.014]. Mortality rate was higher in CAPA cohort (61.8% vs 22.7%, p<0.0001). CAPA resulted an independent risk factor for in-hospital mortality [OR 2.92 (95%CI 1.47-5.89), p=0.0024]. Among CAPA patients, age>65 years resulted a predictor of mortality [OR 5.09 (95%CI 1.20-26.92), p=0.035]. No differences were observed in hematological cohort. <bold>Conclusion:</bold> CAPA is a life-threatening condition with high mortality rates. It should be promptly suspected, especially in case of hematological malignancy, COPD and lymphocytopenia.