Prognostic Impact of Bronchoalveolar Lavage Fluid Galactomannan and Aspergillus Culture Results on Survival in COVID-19 Intensive Care Unit Patients: a Post Hoc Analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-Associated Pulmonary Aspergillosis Study.

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  • Additional Information
    • Corporate Authors:
      ECMM-CAPA Study Group
    • Source:
      Publisher: American Society for Microbiology Country of Publication: United States NLM ID: 7505564 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-660X (Electronic) Linking ISSN: 00951137 NLM ISO Abbreviation: J Clin Microbiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: Washington, American Society for Microbiology.
    • Subject Terms:
      COVID-19*/complications ; Invasive Pulmonary Aspergillosis*/complications ; Invasive Pulmonary Aspergillosis*/diagnosis ; Pulmonary Aspergillosis*; Aspergillus ; Bronchoalveolar Lavage Fluid ; Critical Illness ; Galactose/analogs & derivatives ; Humans ; Intensive Care Units ; Mannans ; Mycology ; Prognosis ; Sensitivity and Specificity
    • Abstract:
      Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), which impacts their chances of survival. Whether positive bronchoalveolar lavage fluid (BALF) mycological tests can be used as a survival proxy remains unknown. We conducted a post hoc analysis of a previous multicenter, multinational observational study with the aim of assessing the differential prognostic impact of BALF mycological tests, namely, positive (optical density index of ≥1.0) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination for critically ill patients with COVID-19. Of the 592 critically ill patients with COVID-19 enrolled in the main study, 218 were included in this post hoc analysis, as they had both test results available. CAPA was diagnosed in 56/218 patients (26%). Most cases were probable CAPA (51/56 [91%]) and fewer were proven CAPA (5/56 [9%]). In the final multivariable model adjusted for between-center heterogeneity, an independent association with 90-day mortality was observed for the combination of positive BALF GM and positive BALF Aspergillus culture in comparison with both tests negative (hazard ratio, 2.53; 95% CI confidence interval [CI], 1.28 to 5.02; P  = 0.008). The other independent predictors of 90-day mortality were increasing age and active malignant disease. In conclusion, the combination of positive BALF GM and positive BALF Aspergillus culture was associated with increased 90-day mortality in critically ill patients with COVID-19. Additional study is needed to explore the possible prognostic value of other BALF markers.
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    • Grant Information:
      UL1 TR001442 United States TR NCATS NIH HHS
    • Contributed Indexing:
      Keywords: Aspergillus; BALF; CAPA; COVID-19; GM; biomarker; galactomannan
    • Accession Number:
      0 (Mannans)
      11078-30-1 (galactomannan)
      X2RN3Q8DNE (Galactose)
    • Publication Date:
      Date Created: 20220324 Date Completed: 20220422 Latest Revision: 20220716
    • Publication Date:
      20250114
    • Accession Number:
      PMC9020339
    • Accession Number:
      10.1128/jcm.02298-21
    • Accession Number:
      35321555