P263 Invasive Pulmonary Aspergillosis (IPA) Among Non-Intubated COVID-19 Patients—a New Age Fungal Storm
Authors: Raghu Raghapriya , Savio Jayanthi 
Published: September 2022

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

Introduction
COVID-19 patients are at higher risk for the development of secondary infections, especially fungal due to multiple risk factors associated with COVID illness and its management. COVID-associated pulmonary aspergillosis (CAPA) is a new clinical entity that is contributing to high morbidity and mortality among immunocompetent COVID-19 patients. Lack of adequate published literature, absence of typical host factors, and lack of specific diagnostic criteria and management algorithms add to the difficulty in early diagnosis and treatment initiation. The scant available data is on CAPA among intubated patients, however, there are no data on CAPA in non-intubated COVID-19 patients.

Objective
The aim of our study was to assess the occurrence of IPA among non-intubated COVID-19 patients and its correlation with their demographic profile, risk factors, morbidity, and outcome.

Methods
This observational study included 24 non-intubated CAPA patients and 72 controls (1:3 randomly selected age and sex matched) at our hospital between April-June 2021. CAPA cases were defined as per modified-AspICU criteria. Demographic characteristics, risk factors, treatment, factors contributing to morbidity, and outcomes were evaluated. Descriptive statistics were reported as mean ± SD, median, number, and percentages. The proportion of CAPA was reported as frequencies and percentages. Clinical characteristics were compared between CAPA and control using Chi-squared, independent t-test and Mann-Whitney U test as appropriate. Association of CAPA with mortality was performed using Fisher's exact test. Logistic regression was performed to assess the factors associated with CAPA. P-value ˂5% was considered statistically significant. All analyses were performed using SPSS 25.0.

Results
A total of 4058 COVID patients were admitted during the study period. Respiratory samples of 26 patients yielded Aspergillus species. Two patients were excluded as colonizers based on modified AspICU criteria. In all, 24 CAPA cases 72 controls were studied for all the variables. CAPA occurrence was 0.59% among non-intubated COVID-19 patients (24/4058).
Both the groups had a male preponderance (75% CAPA, 80% control), the median age was 52.8 ± 14.3. Demographic data and risk factors were comparable. There were no significant differences in lab parameters between the groups. Association of COVID severity and development of CAPA was not statistically significant (mod:OR 2.25, 95% CI, P-value .48; severe:OR 6.65, 95% CI, P-value .08). Significant associations between the cases and controls included, treatment with a higher dose and longer duration of steroids with development of CAPA (dose:OR 1.009, 95% CI, P-value .002; duration:OR 1.09, 95% CI, P-value .006), longer hospital stay (median of 18.4±10days (P-value .008). All-cause mortality was 16.7% in CAPA group (P-value &lt;.0001).
Between CAPA non-survivors and survivors, Serum galactomannan levels (P-value .03), duration of hospital stay (P-value .042), dose and duration of systemic corticosteroid (P-value .001), and duration of oxygen requirement (P-value .05) were found to be statistically significant.

Conclusion
CAPA is an emerging complication with high morbidity and mortality among immunocompetent COVID-19 patients that requires a high index of clinical suspicion. A standard diagnostic criteria and management protocol for early identification and treatment initiation is the need of the hour. Role of steroids in the development of CAPA and the role of galactomannan in diagnosis and prognosis of CAPA needs to be further investigated.