全球COVID-19大流行已导致700多万人死亡,和会使COVID-19的临床病程进一步复杂化。COVID-19和FI(继发性FI)的共感染不仅对医疗保健系统而且对患者生命构成重大威胁。在中国取消对COVID-19的控制措施后,我们观察到相当数量的ICU患者出现COVID-19相关的FI.这迫切需要对ICU环境中的COVID-19患者进行预测性评估,以早期发现疑似真菌感染病例。
■这项研究是一个单中心,回顾性研究努力。我们对严重急性呼吸综合征冠状病毒2(SARS-CoV-2)阳性患者进行了病例对照研究。这些病例包括在长春吉林大学中日协和医院ICU住院期间出现任何继发性FI的患者,吉林省,中国,从12月1日,2022年8月31日2023年。对照组由SARS-CoV-2阳性患者组成,无继发性FI。进行了描述性和比较分析,建立了COVID-19患者继发FI的logistic回归预测模型。此外,我们观察到COVID-19相关肺曲霉病(CAPA)在本次大流行期间的发病率增加.因此,我们在IMF的基础上进行了单变量亚组分析,使用非CAPA患者作为对照亚组。
■从多变量分析,预测模型确定了6个与FI显著相关的因素,包括使用广谱抗生素超过2周(aOR=4.14,95%CI2.03-8.67),发烧(aOR=2.3,95CI1.16-4.55),日志IL-6水平升高(aOR=1.22,95%CI1.04-1.43)和俯卧位通气(aOR=2.38,95CI1.15-4.97)是COVID-19继发FI的独立危险因素。高BMI(BMI≥28kg/m2)(aOR=0.85,95%CI0.75-0.94)和使用COVID-19免疫球蛋白(aOR=0.45,95%CI0.2-0.97)是COVID-19继发性FI的独立保护因素。该模型的受试者工作曲线(ROC)曲线下面积(AUC)为0.81,表明分类良好。
■我们建议特别注意低BMI(BMI<28kg/m2)的COVID-19患者中继发性FI的发生,日志IL-6水平升高和发烧。此外,在COVID-19患者的治疗过程中,我们强调了减少广谱抗生素使用持续时间的重要性,并强调了免疫球蛋白应用在降低国际金融机构发病率方面的潜力.
UNASSIGNED: The global COVID-19 pandemic has resulted in over seven million deaths, and IFI can further complicate the clinical course of COVID-19. Coinfection of COVID-19 and IFI (secondary IFI) pose significant threats not only to healthcare systems but also to patient lives. After the control measures for COVID-19 were lifted in
China, we observed a substantial number of ICU patients developing COVID-19-associated IFI. This creates an urgent need for predictive assessment of COVID-19 patients in the ICU environment for early detection of suspected fungal infection cases.
UNASSIGNED: This study is a single-center, retrospective research endeavor. We conducted a case-control study on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients. The cases consisted of patients who developed any secondary IFI during their ICU stay at Jilin University
China-Japan Union Hospital in Changchun, Jilin Province,
China, from December 1st, 2022, to August 31st, 2023. The control group consisted of SARS-CoV-2 positive patients without secondary IFI. Descriptive and comparative analyses were performed, and a logistic regression prediction model for secondary IFI in COVID-19 patients was established. Additionally, we observed an increased incidence of COVID-19-associated pulmonary aspergillosis (CAPA) during this pandemic. Therefore, we conducted a univariate subgroup analysis on top of IFI, using non-CAPA patients as the control subgroup.
UNASSIGNED: From multivariate analysis, the prediction model identified 6 factors that are significantly associated with IFI, including the use of broad-spectrum antibiotics for more than 2 weeks (aOR=4.14, 95% CI 2.03-8.67), fever (aOR=2.3, 95%CI 1.16-4.55), elevated log IL-6 levels (aOR=1.22, 95% CI 1.04-1.43) and prone position ventilation (aOR=2.38, 95%CI 1.15-4.97) as independent risk factors for COVID-19 secondary IFI. High BMI (BMI ≥ 28 kg/m2) (aOR=0.85, 95% CI 0.75-0.94) and the use of COVID-19 immunoglobulin (aOR=0.45, 95% CI 0.2-0.97) were identified as independent protective factors against COVID-19 secondary IFI. The Receiver Operating Curve (ROC) area under the curve (AUC) of this model was 0.81, indicating good classification.
UNASSIGNED: We recommend paying special attention for the occurrence of secondary IFI in COVID-19 patients with low BMI (BMI < 28 kg/m2), elevated log IL-6 levels and fever. Additionally, during the treatment of COVID-19 patients, we emphasize the importance of minimizing the duration of broad-spectrum antibiotic use and highlight the potential of immunoglobulin application in reducing the incidence of IFI.