COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a relatively common complication. Multiple studies described this relationship in critical patients, however its incidence and outcome in other risk groups such as immunosuppressed patients remains unknown. In this sense, we aimed to evaluate the rates and outcomes of CAPA in hematological patients and according to the different hematological malignances, comparing to invasive pulmonary aspergillosis (IPA) in non-COVID-19 ones. Nationwide, population-based and retrospective observational cohort study including all adult patients with hematological malignancies admitted in Spain since March 1, 2020 to December 31, 2021. The main outcome variable was the diagnosis of IPA during hospitalization in hematological patients with or without COVID-19 at admission. The rate of CAPA compared to IPA in non-COVID-19 patients in each hematological malignancy was also performed, as well as survival curve analysis. COVID-19 was diagnosed in 3.85 % (4367 out of 113,525) of the hematological adult inpatients. COVID-19 group developed more fungal infections (5.1 % 3 %; p < 0.001). Candida spp. showed higher rate in non-COVID-19 (74.2 % 66.8 %; p = 0.015), meanwhile Aspergillus spp. confirmed its predominance in COVID-19 hematological patients (35.4 % 19.1 %; p < 0.001). IPA was diagnosed in 703 patients and 11.2 % (79 cases) were CAPA. The multivariate logistic regression analysis found that the diagnosis of COVID-19 disease at hospital admission increased more than two-fold IPA development [OR: 2.5, 95CI (1.9–3.1), p < 0.001]. B-cell malignancies – specifically B-cell non-Hodgkin lymphoma, multiple myeloma, chronic lymphocytic leukemia and acute lymphoblastic leukemia – showed between four- and six-fold higher CAPA development and 90-day mortality rates ranging between 50 % and 72 %. However, myeloid malignancies did not show higher CAPA rates compared to IPA in non-COVID-19 patients. COVID-19 constitutes an independent risk factor for developing aspergillosis in B-cell hematological malignancies and the use of antifungal prophylaxis during hospitalizations may be warranted.

中文翻译：

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血液病患者中的 COVID-19 相关肺曲霉病 (CAPA)：是否需要抗真菌预防？一项全国性研究

COVID-19 相关肺曲霉病 (CAPA) 已成为一种相对常见的并发症。多项研究描述了危重患者中的这种关系，但其在其他风险群体（例如免疫抑制患者）中的发生率和结果仍然未知。从这个意义上说，我们的目的是根据不同的血液恶性肿瘤评估血液病患者中 CAPA 的发生率和结果，并与非 COVID-19 患者中的侵袭性肺曲霉病 (IPA) 进行比较。全国性、基于人群的回顾性观察队列研究，包括自 2020 年 3 月 1 日至 2021 年 12 月 31 日在西班牙收治的所有成年血液恶性肿瘤患者。主要结果变量是患有或不患有 COVID 的血液病患者在住院期间诊断出 IPA。入院时19岁。还对每种血液恶性肿瘤的非 COVID-19 患者中 CAPA 与 IPA 的发生率进行了比较，并进行了生存曲线分析。 3.85%（113,525 名血液学成人住院患者中的 4367 名）被诊断出患有 COVID-19。 COVID-19 组出现更多真菌感染 (5.1 % 3 %；p < 0.001)。念珠菌属在非 COVID-19 中表现出更高的比率（74.2 % 66.8 %；p = 0.015），同时曲霉菌属。证实了其在 COVID-19 血液病患者中的优势（35.4 % 19.1 %；p < 0.001）。 703 名患者中诊断出 IPA，其中 11.2%（79 例）为 CAPA。多变量逻辑回归分析发现，入院时诊断出的 COVID-19 疾病使 IPA 发展增加两倍以上 [OR：2.5，95CI (1.9–3.1)，p < 0.001]。 B 细胞恶性肿瘤，特别是 B 细胞非霍奇金淋巴瘤、多发性骨髓瘤、慢性淋巴细胞白血病和急性淋巴细胞白血病，CAPA 发生率高出四到六倍，90 天死亡率在 50% 到 72% 之间。然而，与非 COVID-19 患者中的 IPA 相比，骨髓恶性肿瘤并未表现出更高的 CAPA 率。 COVID-19 是 B 细胞血液恶性肿瘤中发生曲霉病的独立危险因素，住院期间可能需要使用抗真菌预防药物。