TY - JOUR
T1 - Incidence and mortality of COVID-19-associated pulmonary aspergillosis
T2 - A systematic review and meta-analysis
AU - Mitaka, Hayato
AU - Kuno, Toshiki
AU - Takagi, Hisato
AU - Patrawalla, Paru
N1 - Publisher Copyright:
© 2021 Wiley-VCH GmbH
PY - 2021/9
Y1 - 2021/9
N2 - COVID-19-associated pulmonary aspergillosis (CAPA) has been reported worldwide. However, basic epidemiological characteristics have not been well established. In this systematic review and meta-analysis, we aimed to determine the incidence and mortality of CAPA in critically ill patients with COVID-19 to improve guidance on surveillance and prognostication. Observational studies reporting COVID-19-associated pulmonary aspergillosis were searched with PubMed and Embase databases, followed by an additional manual search in April 2021. We performed a one-group meta-analysis on the incidence and mortality of CAPA using a random-effect model. We identified 28 observational studies with a total of 3148 patients to be included in the meta-analysis. Among the 28 studies, 23 were conducted in Europe, two in Mexico and one each in China, Pakistan and the United States. Routine screening for secondary fungal infection was employed in 13 studies. The modified AspICU algorithm was utilised in 15 studies and was the most commonly used case definition and diagnostic algorithm for pulmonary aspergillosis. The incidence and mortality of CAPA in the ICU were estimated to be 10.2% (95% CI, 8.0–12.5; I2 = 82.0%) and 54.9% (95% CI, 45.6–64.2; I2 = 62.7%), respectively. In conclusion, our estimates may be utilised as a basis for surveillance of CAPA and prognostication in the ICU. Large, prospective cohort studies based on the new case definitions of CAPA are warranted to validate our estimates.
AB - COVID-19-associated pulmonary aspergillosis (CAPA) has been reported worldwide. However, basic epidemiological characteristics have not been well established. In this systematic review and meta-analysis, we aimed to determine the incidence and mortality of CAPA in critically ill patients with COVID-19 to improve guidance on surveillance and prognostication. Observational studies reporting COVID-19-associated pulmonary aspergillosis were searched with PubMed and Embase databases, followed by an additional manual search in April 2021. We performed a one-group meta-analysis on the incidence and mortality of CAPA using a random-effect model. We identified 28 observational studies with a total of 3148 patients to be included in the meta-analysis. Among the 28 studies, 23 were conducted in Europe, two in Mexico and one each in China, Pakistan and the United States. Routine screening for secondary fungal infection was employed in 13 studies. The modified AspICU algorithm was utilised in 15 studies and was the most commonly used case definition and diagnostic algorithm for pulmonary aspergillosis. The incidence and mortality of CAPA in the ICU were estimated to be 10.2% (95% CI, 8.0–12.5; I2 = 82.0%) and 54.9% (95% CI, 45.6–64.2; I2 = 62.7%), respectively. In conclusion, our estimates may be utilised as a basis for surveillance of CAPA and prognostication in the ICU. Large, prospective cohort studies based on the new case definitions of CAPA are warranted to validate our estimates.
KW - COVID-19
KW - SARS-CoV-2
KW - acute respiratory distress syndrome
KW - pulmonary aspergillosis
UR - http://www.scopus.com/inward/record.url?scp=85105134025&partnerID=8YFLogxK
U2 - 10.1111/myc.13292
DO - 10.1111/myc.13292
M3 - Review article
C2 - 33896063
AN - SCOPUS:85105134025
SN - 0933-7407
VL - 64
SP - 993
EP - 1001
JO - Mycoses
JF - Mycoses
IS - 9
ER -