Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study

Daniele Roberto Giacobbe; Juergen Prattes; Joost Wauters; Silvia  Dettori; Alessio Signori; Jon Salmanton‐garcía; Johan Maertens; Marc Bourgeois; Marijke Reynders; Lynn Rutsaert; Niels Van Regenmortel; Piet Lormans; Simon Feys; Nikolay Klimko; Olga  Shadrivova; Oliver A Cornely; Riina Rautemaa-Richardson; Philipp Koehler; Katrien Lagrou; Matteo Bassetti; Martin Hoenigl

Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study

Daniele Roberto Giacobbe, Juergen Prattes, Joost Wauters, Silvia Dettori, Alessio Signori, Jon Salmanton‐garcía, Johan Maertens, Marc Bourgeois, Marijke Reynders, Lynn Rutsaert, Niels Van Regenmortel, Piet Lormans, Simon Feys, Nikolay Klimko, Olga Shadrivova, Oliver A Cornely, Riina Rautemaa-Richardson , Philipp Koehler, Katrien Lagrou, Matteo BassettiMartin Hoenigl

Division of Evolution, Infection and Genomics

Research output: Contribution to journal › Article › peer-review

Abstract

Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), that impact 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 (≥ 1.0 optical density index) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination in critically ill patients with COVID-19. Of the 592 patients 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 1.28-5.02, 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.

Key words: CAPA; GM; biomarker; galactomannan; Aspergillus; COVID-19; BALF.

Original language	English
Journal	Journal of clinical microbiology
Publication status	Accepted/In press - 15 Feb 2022

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Giacobbe, D. R., Prattes, J., Wauters, J., Dettori, S., Signori, A., Salmanton‐garcía, J., Maertens, J., Bourgeois, M., Reynders, M., Rutsaert, L., Van Regenmortel, N., Lormans, P., Feys, S., Klimko, N., Shadrivova, O., Cornely, O. A., Rautemaa-Richardson , R., Koehler, P., Lagrou, K., ... Hoenigl, M. (Accepted/In press). Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study. Journal of clinical microbiology.

Giacobbe, Daniele Roberto ; Prattes, Juergen ; Wauters, Joost et al. / Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study. In: Journal of clinical microbiology. 2022.

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title = "Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study",

abstract = "Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), that impact 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 (≥ 1.0 optical density index) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination in critically ill patients with COVID-19. Of the 592 patients 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 1.28-5.02, 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.Key words: CAPA; GM; biomarker; galactomannan; Aspergillus; COVID-19; BALF.",

author = "Giacobbe, {Daniele Roberto} and Juergen Prattes and Joost Wauters and Silvia Dettori and Alessio Signori and Jon Salmanton‐garc{\'i}a and Johan Maertens and Marc Bourgeois and Marijke Reynders and Lynn Rutsaert and {Van Regenmortel}, Niels and Piet Lormans and Simon Feys and Nikolay Klimko and Olga Shadrivova and Cornely, {Oliver A} and Riina Rautemaa-Richardson and Philipp Koehler and Katrien Lagrou and Matteo Bassetti and Martin Hoenigl",

year = "2022",

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language = "English",

journal = "Journal of clinical microbiology",

issn = "0095-1137",

publisher = "American Society for Microbiology",

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Giacobbe, DR, Prattes, J, Wauters, J, Dettori, S, Signori, A, Salmanton‐garcía, J, Maertens, J, Bourgeois, M, Reynders, M, Rutsaert, L, Van Regenmortel, N, Lormans, P, Feys, S, Klimko, N, Shadrivova, O, Cornely, OA, Rautemaa-Richardson , R, Koehler, P, Lagrou, K, Bassetti, M & Hoenigl, M 2022, 'Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study', Journal of clinical microbiology.

Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study. / Giacobbe, Daniele Roberto; Prattes, Juergen; Wauters, Joost et al.

In: Journal of clinical microbiology, 15.02.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study

AU - Giacobbe, Daniele Roberto

AU - Prattes, Juergen

AU - Wauters, Joost

AU - Dettori, Silvia

AU - Signori, Alessio

AU - Salmanton‐garcía, Jon

AU - Maertens, Johan

AU - Bourgeois, Marc

AU - Reynders, Marijke

AU - Rutsaert, Lynn

AU - Van Regenmortel, Niels

AU - Lormans, Piet

AU - Feys, Simon

AU - Klimko, Nikolay

AU - Shadrivova, Olga

AU - Cornely, Oliver A

AU - Rautemaa-Richardson , Riina

AU - Koehler, Philipp

AU - Lagrou, Katrien

AU - Bassetti, Matteo

AU - Hoenigl, Martin

PY - 2022/2/15

Y1 - 2022/2/15

N2 - Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), that impact 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 (≥ 1.0 optical density index) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination in critically ill patients with COVID-19. Of the 592 patients 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 1.28-5.02, 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.Key words: CAPA; GM; biomarker; galactomannan; Aspergillus; COVID-19; BALF.

AB - Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), that impact 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 (≥ 1.0 optical density index) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination in critically ill patients with COVID-19. Of the 592 patients 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 1.28-5.02, 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.Key words: CAPA; GM; biomarker; galactomannan; Aspergillus; COVID-19; BALF.

M3 - Article

JO - Journal of clinical microbiology

JF - Journal of clinical microbiology

SN - 0095-1137

ER -

Giacobbe DR, Prattes J, Wauters J, Dettori S, Signori A, Salmanton‐garcía J et al. Prognostic impact of bronchoalveolar lavage galactomannan and Aspergillus culture results on survival in COVID-19 ICU patients: a post-hoc analysis from the European Confederation of Medical Mycology (ECMM) COVID-19-associated pulmonary aspergillosis (CAPA) Study. Journal of clinical microbiology. 2022 Feb 15.