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

• Main Authors: Bassetti, M. (Author), Bourgeois, M. (Author), Cornely, O.A (Author), Dettori, S. (Author), ECMM-CAPA Study Group (Author), Feys, S. (Author), Giacobbe, D.R (Author), Hoenigl, M. (Author), Klimko, N. (Author), Koehler, P. (Author), Lagrou, K. (Author), Lormans, P. (Author), Maertens, J. (Author), Prattes, J. (Author), Rautemaa-Richardson, R. (Author), Reynders, M. (Author), Rutsaert, L. (Author), Salmanton-García, J. (Author), Shadrivova, O. (Author), Signori, A. (Author), Van Regenmortel, N. (Author), Wauters, J. (Author)
• Format: Article
• Language: English
• Published: NLM (Medline) 2022
• Subjects: Aspergillus; BALF; biomarker; bronchoalveolar lavage fluid; Bronchoalveolar Lavage Fluid; CAPA; complication; COVID-19; critical illness; Critical Illness; galactomannan; galactose; Galactose; GM; human; Humans; intensive care unit; Intensive Care Units; invasive aspergillosis; Invasive Pulmonary Aspergillosis; lung aspergillosis; mannan; Mannans; mycology; Mycology; prognosis; Prognosis; Pulmonary Aspergillosis; sensitivity and specificity; Sensitivity and Specificity
• Online Access: View Fulltext in Publisher

 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.