BACKGROUND: This study aimed to identify factors that influence the mortality rate of patients with coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA). METHODS: In this cross-sectional study, data from 23 centers across 15 countries, spanning the period of March 2020 to December 2021, were retrospectively collected. The study population comprised patients who developed invasive pulmonary aspergillosis while being treated for COVID-19 in the intensive care unit. Cox regression and decision tree analyses were used to identify factors associated with mortality in patients with CAPA. RESULTS: A total of 162 patients (males, 65.4 %; median age: 64 [25th-75th: 54.0-73.8] years) were included in the study, of whom 113 died during the 90-day follow-up period. The median duration from CAPA diagnosis to death was 12 (25th-75th: 7-19) days. In the multivariable Cox regression model, an age of ≥65 years (hazard ratio [HR]: 2.05, 95 % confidence interval [CI]: 1.37-3.07), requiring vasopressor therapy at the time of CAPA diagnosis (HR: 1.80, 95 % CI: 1.17-2.76), and receiving renal replacement therapy at the time of CAPA diagnosis (HR: 2.27, 95 % CI: 1.35-3.82) were identified as predictors of mortality. Decision tree analysis revealed that patients with CAPA aged ≥65 years who received corticosteroid treatment for COVID-19 displayed higher mortality rates (estimated rate: 1.6, observed in 46 % of patients). CONCLUSION: This study concluded that elderly patients with CAPA who receive corticosteroids are at a significantly higher risk of mortality, particularly if they experience multiorgan failure.

Ataturk University Faculty of Medicine Department of Haematology Erzurum Turkey

Ataturk University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology Erzurum Turkey

Cairo University Faculty of Medicine Department of Clinical Pathology Cairo Egypt

Canakkale Onsekiz Mart University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology Canakkale Turkey

Carol Davila University of Medicine and Pharmacy Bucharest Romania

Central Research Institute of Epidemiology Department of Infectious Diseases Moscow Russia

Clinic for Lung Diseases University Hospital Centre Zagreb Zagreb Croatia

Communicable Disease Center Infectious Disease Medicine Department Hamad Medical Corporation Doha Qatar

Department of Infectious Diseases School of Medicine Isfahan University of Medical Sciences Isfahan Iran

Department of Surgical Oncological and Oral Science University of Palermo Department of Anesthesia Intensive Care and Emergency University Hospital Policlinico Paolo Giaccone Palermo Italy

Dokuz Eylul University Research and Application Hospital Izmir Turkey

Ege University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology Izmir Turkey

Erciyes University Faculty of Medicine Department of Anesthesiology and Reanimation Kayseri Turkey

Hospital Nitra Department of Clinical Microbiology St Elizabeth University of Health and Social Sciences Bratislava Slovakia

Istanbul Medipol University Infectious Diseases and Clinical Microbiology Istanbul Turkey

Istanbul Medipol University Medical School Istanbul Turkey

Jahangirnagar University Department of Public Health and Informatics Savar Dhaka Bangladesh

National Cancer Institute Cairo University Children's Cancer Hospital Egypt Department of Pediatric Oncology Cairo Egypt

National Institute for Infectious Diseases Matei Bals Bucharest Romania

Ovidius University of Constanța Clinical Infectious Diseases Hospital Constanța Romania

Salmaniya Medical Complex Manama Bahrain

Shifa Tameer e Millat University and Shifa International Hospital Infectious Diseases Division Islamabad Pakistan

South Pest Central Hospital National Institute of Hematology and Infectious Diseases Budapest Hungary

Université Libre de Bruxelles Saint Pierre University Hospital Infectious Diseases Department Bruxelles Belgium

University Hospital Brno and Faculty of Medicine Masaryk University Department of Infectious Diseases Brno Czech Republic

University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital Infectious Diseases and Clinical Microbiology Ankara Turkey

University of Health Sciences Gulhane School of Medicine Department of Infectious Diseases and Clinical Microbiology Ankara Turkey

University of Health Sciences Van Training and Research Hospital Van Turkey

University of Jordan School of Medicine Amman Jordan

University of Zagreb School of Medicine Zagreb Croatia

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