Clinical characteristics and prognosis of COVID-19-associated pulmonary aspergillosis in elderly patients on maintenance hemodialysis
Objective To analyze the clinical characteristics and prognosis of COVID-19-associated pulmonary aspergillosis(CAPA)in elderly patients with severe COVID-19 on maintenance hemodialysis(MHD).Methods Data of patients aged 60 years or older with severe COVID-19 treated at the Blood Purification Center of Beijing Friendship Hospital Affiliated to Capital Medical University between December 2022 and January 2023 were retrospectively analyzed.Patients were divided into a CAPA group and a non-CAPA group,based on the existence of proven or probable CAPA.The demographics,clinical characteristics and treatment measures between the two groups were compared.Risk factors for CAPA in elderly patients on MHD and their influence on prognosis were examined.Results A total of 56 patients were enrolled(42 men and 14 women),with an age of 66.0(60.0-75.0)years and dialysis vintage of 24(66-144)months.Twenty cases(35.7％)had concurrent diabetes.The overall 30-day mortality rate was 18/56(32.1％).Twelve cases(21.4％)developed CAPA during the course.The median time to a confirmed diagnosis of CAPA was 16(9-23)days.The prominent clinical manifestations included hemoptysis,chest tightness,continuously worsening C-reactive protein levels,and poor response to antibiotic treatment.Eight CAPA patients(66.7％)died.Increased age(OR=1.119,95％CI:1.025-1.890)and use of glucocorticoids(OR=6.228,95％CI:1.079-39.954)were independent risk factors of CAPA.CAPA was independently related to death(OR=6.979,95％CI:1.455-33.476).Conclusions Elderly MHD patients with severe COVID-19 are at high risk for CAPA,which has a very poor prognosis.Clinicians should pay particularly attention to this issue.
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