Clinical characteristics and prognosis of COVID-19- associated invasive pulmonary aspergillosis in critically patients: a single-center study

17 (29.3%) of the 58 critically ill patients were diagnosed with CAPA, of which 10 (58.82%) patients were Probable CAPA and 7 (41.18%) patients were Possible CAPA. Among this <i>Aspergillus</i> strains, <i>Aspergillus fumigatus</i> strains were found in 13 cases (76.47%) and <i>Aspergillus niger</i> strains in 4 cases (23.53%). 7 (41.18%) patients had concomitant bacterial fungal infections with a mortality rate of 57.14% (4/7), of which <i>Acinetobacter baumannii</i> was the most common pathogen. Among the patients with CAPA, galactomannan assay of bronchoalveolar lavage fluid (BALF) was performed in 5 patients with a 100% (5/5) positivity rate, and two or more serum galactomannan (GM) assays were performed in 17 patients, with a probability of favorable results in both cases of 41.2% (7/17). The 60-day mortality rate in patients with CAPA was 52.9% (9/17), whereas the non-CAPA patients had a 60-day mortality rate of 24.4% (10/41), which was statistically different (P = 0.035). Diabetes mellitus (P = 0.018, OR: 5.040 (95% CI: 1.314-19.337)), renal insufficiency (P=0.002, OR: 11.259 (95% CI: 2.480-51.111)), chronic obstructive pulmonary disease (COPD) (P = 0.003, OR: 6.939 (95% CI: 1.963-24.531)), elevated interleukin-6 (IL-6) (P = 0.022, OR: 4.160 (95% CI: 1.226~14.113)), mechanical ventilation (P = 0.002, OR: 8.100 (95%CI: 2.132~30.777)), increased duration of steroids use (P = 0.022, OR: 1.071 (95%CI: 1.010~1.135)), increased cumulative dose of steroids use ((P < 0.001, OR: 1.012 (95%CI: 1.009~1.015)), use of tocilizumab (P = 0.020, OR: 11.480 (95%CI: 2.480~51.111)), and increased length of hospitalization in ICU (P = 0.021, OR: 1.038 (95% CI: 1.006 to 1.071)), and increase in the type of antibiotics used (P = 0.002, OR: 1.603 (95% CI: 1.181 to 2.176)) were the risk factors for the occurrence of fungal infections, whereas the use of steroids or not, the use of baricitinib or not, and hypertension did not have a significant effect on the occurrence of fungal infections (P > 0.05). Patients with CAPA had a higher mortality rate, and their hospitalization was prolonged compared to non-CAPA patients. The all-cause mortality rate for patients with CAPA was 52.9%. We also performed univariate and multivariate analyses of potential factors associated with mortality, including the use of mechanical ventilation (P = 0.040 OR: 10.500, (95% CI: 1.115 to 98.914)), advanced age (P = 0.043 OR: 1.212, (95% CI: 1.006 to 1.460)), and a significantly higher CRP level (P = 0.042 OR: 1.043, (95% CI: 1.002~1.078)) had a worse prognosis. Steroids use, gender, and diabetes mellitus were not associated with patient death (P > 0.05).