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Meta-Analysis
. 2021 Sep;64(9):993-1001.
doi: 10.1111/myc.13292. Epub 2021 May 6.

Incidence and mortality of COVID-19-associated pulmonary aspergillosis: A systematic review and meta-analysis

Hayato Mitaka  1 , Toshiki Kuno  1 , Hisato Takagi  2 , Paru Patrawalla  3
Affiliations
Meta-Analysis

Incidence and mortality of COVID-19-associated pulmonary aspergillosis: A systematic review and meta-analysis

Hayato Mitaka et al. Mycoses. 2021 Sep.

Abstract

COVID-19-associated pulmonary aspergillosis (CAPA) has been reported worldwide. However, basic epidemiological characteristics have not been well established. In this systematic review and meta-analysis, we aimed to determine the incidence and mortality of CAPA in critically ill patients with COVID-19 to improve guidance on surveillance and prognostication. Observational studies reporting COVID-19-associated pulmonary aspergillosis were searched with PubMed and Embase databases, followed by an additional manual search in April 2021. We performed a one-group meta-analysis on the incidence and mortality of CAPA using a random-effect model. We identified 28 observational studies with a total of 3148 patients to be included in the meta-analysis. Among the 28 studies, 23 were conducted in Europe, two in Mexico and one each in China, Pakistan and the United States. Routine screening for secondary fungal infection was employed in 13 studies. The modified AspICU algorithm was utilised in 15 studies and was the most commonly used case definition and diagnostic algorithm for pulmonary aspergillosis. The incidence and mortality of CAPA in the ICU were estimated to be 10.2% (95% CI, 8.0-12.5; I2 = 82.0%) and 54.9% (95% CI, 45.6-64.2; I2 = 62.7%), respectively. In conclusion, our estimates may be utilised as a basis for surveillance of CAPA and prognostication in the ICU. Large, prospective cohort studies based on the new case definitions of CAPA are warranted to validate our estimates.

Keywords: COVID-19; SARS-CoV-2; acute respiratory distress syndrome; pulmonary aspergillosis.

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Conflict of interest statement

There are no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flow diagram of study selection
FIGURE 2
FIGURE 2
Forrest plot showing the pooled estimate of the incidence of COVID‐19‐associated pulmonary aspergillosis in the ICU
FIGURE 3
FIGURE 3
Forrest plot showing the pooled estimate of the mortality of COVID‐19‐associated pulmonary aspergillosis in the ICU
See this image and copyright information in PMC

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