定义 COVID-19 相关肺曲霉病：系统评价和荟萃分析。
Defining COVID-19-associated pulmonary aspergillosis: systematic review and meta-analysis.
机构信息
Division of Diagnostic & Applied Microbiology, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada; Alberta Precision Laboratories-Public Health, Edmonton, Alberta, Canada.
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
出版信息
Clin Microbiol Infect. 2022 Jul;28(7):920-927. doi: 10.1016/j.cmi.2022.01.027. Epub 2022 Feb 10.
BACKGROUND
Pulmonary aspergillosis may complicate coronavirus disease 2019 (COVID-19) and contribute to excess mortality in intensive care unit (ICU) patients. The disease is poorly understood, in part due to discordant definitions across studies.
OBJECTIVES
We sought to review the prevalence, diagnosis, treatment, and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) and compare research definitions.
DATA SOURCES
PubMed, Embase, Web of Science, and MedRxiv were searched from inception to October 12, 2021.
STUDY ELIGIBILITY CRITERIA
ICU cohort studies and CAPA case series including ≥3 patients were included.
PARTICIPANTS
Adult patients in ICUs with COVID-19.
INTERVENTIONS
Patients were reclassified according to four research definitions. We assessed risk of bias with an adaptation of the Joanna Briggs Institute cohort checklist tool for systematic reviews.
METHODS
We calculated CAPA prevalence using the Freeman-Tukey random effects method. Correlations between definitions were assessed with Spearman's rank test. Associations between antifungals and outcome were assessed with random effects meta-analysis.
RESULTS
Fifty-one studies were included. Among 3297 COVID-19 patients in ICU cohort studies, 313 were diagnosed with CAPA (prevalence 10%; 95% CI 8%-13%). Two hundred seventy-seven patients had patient-level data allowing reclassification. Definitions had limited correlation with one another (ρ = 0.268-0.447; p < 0.001), with the exception of Koehler and Verweij (ρ = 0.893; p < 0.001); 33.9% of patients reported to have CAPA did not fulfill any research definitions. Patients were diagnosed after a median of 8 days (interquartile range 5-14) in ICUs. Tracheobronchitis occurred in 3% of patients examined with bronchoscopy. The mortality rate was high (59.2%). Applying CAPA research definitions did not strengthen the association between mould-active antifungals and survival.
CONCLUSIONS
The reported prevalence of CAPA is significant but may be exaggerated by nonstandard definitions.
背景
肺曲霉病可能使 2019 年冠状病毒病（COVID-19）复杂化，并导致重症监护病房（ICU）患者的死亡率升高。该疾病的了解程度较差，部分原因是研究之间存在不一致的定义。
目的
我们旨在回顾 COVID-19 相关肺曲霉病（CAPA）的患病率、诊断、治疗和结局，并比较研究定义。
数据来源
从建库到 2021 年 10 月 12 日，我们在 PubMed、Embase、Web of Science 和 MedRxiv 上进行了检索。
研究入选标准
纳入 ICU 队列研究和 CAPA 病例系列，每个研究均纳入≥3 例患者。
研究对象
入住 ICU 的 COVID-19 成年患者。
干预措施
根据四个研究定义对患者进行重新分类。我们使用 Joanna Briggs 研究所队列清单工具的改编版评估偏倚风险，用于系统评价。
方法
我们使用 Freeman-Tukey 随机效应法计算 CAPA 的患病率。使用 Spearman 秩相关检验评估定义之间的相关性。使用随机效应荟萃分析评估抗真菌药物与结局之间的关联。
结果
共纳入 51 项研究。在 3297 例 ICU 队列研究中的 COVID-19 患者中，有 313 例被诊断为 CAPA（患病率为 10%；95%CI 8%-13%）。277 例患者有患者水平数据，允许重新分类。各定义之间相关性有限（ρ=0.268-0.447；p<0.001），除了 Koehler 和 Verweij 定义（ρ=0.893；p<0.001）外；报告有 CAPA 的 33.9%的患者不符合任何研究定义。患者在 ICU 中平均经过 8 天（四分位距 5-14）被诊断。支气管镜检查发现 3%的患者患有气管支气管炎。死亡率很高（59.2%）。应用 CAPA 研究定义并没有增强模式活性抗真菌药物与生存之间的关联。
结论
报告的 CAPA 患病率很高，但可能因非标准定义而被夸大。
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