Immune Profile and Risk of COVID-19-Associated Pulmonary Aspergillosis (CAPA): A Multicenter Retrospective Study with Matching Cohorts

Abstract

Background: The anti-inflammatory effects of COVID-19 and its treatment may promote COVID-19-associated pulmonary aspergillosis (CAPA). This study aimed to investigate the immunological profile associated with CAPA in ICU patients. Methods: We conducted a retrospective study in three French ICUs. Severe COVID-19 patients who underwent immunological profiling within 10 days of ICU admission were included. CAPA patients were matched with non-CAPA patients to assess risk factors. Results: Among 479 non-CAPA patients, 52 were matched with 28 CAPA patients. CAPA patients more frequently required organ support (p < 0.01), but mortality rates were similar. At ICU admission and day 7, CAPA patients had higher serum IL-6, IL-10, and IL-6/mHLA-DR ratios. In univariate conditional logistic regression an mHLA-DR expression > 8000 antibodies/cell at admission was associated with lower CAPA (OR = 0.41 [0.17–0.99], p = 0.04) and CAPA or death (OR = 0.26 [0.08–0.81], p = 0.04). An IL-6/mHLA-DR ratio > 2.8 tended to be associated with CAPA or death (OR = 3.16 [0.98–10.21], p = 0.05). Multivariate analysis did not find an association between immunological data and development of CAPA. Conclusion: We did not find an association between early immunological profiling data and development of CAPA in multivariate analysis. However, mHLA-DR, IL-10 and IL-6/mHLA-DR ratios may be interesting directions for future research with larger cohorts.