# High mortality and mechanical ventilation in COVID-19-associated pulmonary aspergillosis: insights from a two-center retrospective cohort study

## TL;DR

This study found that CAPA in ICU patients infected with Alpha and Omicron variants of SARS-CoV-2 is associated with high mortality and increased need for mechanical ventilation.

## Contribution

The study compares CAPA mortality rates and incidence between patients infected with Alpha and Omicron variants in two Chinese hospitals.

## Key findings

- CAPA mortality rates were 33.3% for Alpha and 28.6% for Omicron, significantly higher than non-CAPA patients.
- Aspergillus fumigatus was the most common cause of CAPA, with only one case of Aspergillus flavus.
- Mechanical ventilation was frequently required in CAPA patients, highlighting the severity of the condition.

## Abstract

Studies on COVID-19-associated pulmonary aspergillosis (CAPA) have raised concerns regarding its high mortality rates. This study aims to assess the mortality of CAPA caused by Alpha and Omicron variants among intensive care unit (ICU) patients in China.

We enrolled 236 ICU patients admitted to Wuhan Huoshenshan Hospital from 4 January 2020, to 30 March 2022, during the Alpha variant epidemic, and 187 ICU patients admitted to Nanjing Jinling Hospital from 24 October 2022, to 19 January 2023, during the Omicron variant epidemic. We systematically collected clinical data for analysis, and all patients were confirmed to have SARS-CoV-2 infection through polymerase chain reaction (PCR) testing.

The incidence of CAPA was 5.1% (12/236) during the Alpha variant period and increased to 7.5% (14/187) during the Omicron variant period. The mortality rate among CAPA cases was 33.3% (4/12) for patients infected with the Alpha variant and 28.6% (4/14) for those infected with the Omicron variant. Both rates were higher than the mortality rates among patients without CAPA, which were 4.9% (11/224) during the Alpha period and 8.7% (15/173) during the Omicron period. Mechanical ventilation in CAPA patients requires careful consideration. Aspergillus fumigatus was the most commonly identified causative agent in CAPA cases, while Aspergillus flavus was found in only one case.

Our findings emphasize the necessity of implementing more effective mycological detection methods and promoting internationally recognized diagnostic criteria for CAPA.