Fungal Infections in the ICU during the COVID-19 Era: Descriptive and Comparative Analysis of 178 Patients
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. Fungal Infection Patients’ Characteristics
3.2. COVID-19 Associated Candidemia
3.3. COVID-19 Associated Pulmonary Aspergillosis
3.4. Risk Factor Differences
3.5. Outcome Differences
3.6. Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics | Total (n = 178) | Fungal Infection | p-Value | ||
---|---|---|---|---|---|
No | Yes | ||||
Age (median, IQR) | 66 (55–73) | 66 (57–74) | 52 (43–70) | 0.008 | |
Gender (n, %) | Male | 131 (73.6) | 117 (73.6) | 14 (73.7) | 0.99 |
Female | 47 (26.4) | 42 (26.4) | 5 (26.3) | ||
BMI (median, IQR) | 29 (26–33.9) | 29.3 (26–34) | 27.3 (25.7–31.2) | 0.24 | |
Smoking habit (n, %) | Never | 105 (59) | 93 (58.5) | 12 (63.2) | 0.65 |
Current | 22 (12.4) | 19 (12) | 3 (15.8) | ||
Former | 51 (28.6) | 47 (29.5) | 4 (21) | ||
Charlson Comorbidity Index (median, IQR) | 3 (1–4) | 3 (1–4) | 1 (0–3) | 0.016 | |
Respiratory disease (n, %) | 29 (16.3) | 26 (16.4) | 3 (15.8) | >0.99 | |
Diabetes (n, %) | 44 (24.7) | 42 (26.4) | 2 (10.5) | 0.17 | |
Hypertension (n, %) | 88 (49.4) | 81 (50.9) | 7 (36.8) | 0.25 | |
Thyroid disease (n, %) | 21 (11.8) | 18 (11.3) | 3 (15.8) | 0.47 | |
Chronic Heart Disease (n, %) | 25 (14) | 25 (15.7) | 0 (0) | 0.079 | |
Stroke (n, %) | 3 (1.7) | 2 (1.3) | 1 (5.3) | 0.29 | |
Asthma (n, %) | 10 (5.6) | 9 (5.7) | 1 (5.3) | >0.99 | |
Dyslipidemia (n, %) | 44 (24.7) | 39 (24.5) | 5 (26.3) | 0.86 | |
COPD (n, %) | 15 (8.4) | 14 (8.8) | 1 (5.3) | >0.99 | |
SAPS III (median, IQR) | 50 (45–55) | 50 (45–55) | 47 (41–53) | 0.11 | |
APACHE II (median, IQR) | 12 (10–17) | 12 (10–17) | 13 (8–15) | 0.41 | |
SOFA (median, IQR) | 6 (3–7) | 6 (3–7) | 6 (2–7) | 0.56 | |
Arrived Intubated (n, %) | 135 (75.8) | 124 (78) | 11 (57.9) | 0.053 | |
Intubation in the ICU (n, %) | 43 (24.2) | 35 (22) | 8 (42.1) | ||
PF ratio day 1 (median, IQR) | 109 (78.3–149.5) | 110.9 (80–152) | 84 (63–129.1) | 0.013 | |
PF ratio day 4 (median, IQR) | 141.7 (102.8–184) | 144.5 (106.3–184) | 117.8 (83.2–164.6) | 0.08 | |
PF ratio day 7 (median, IQR) | 128.3 (97.1–173) | 128.3 (100.5–173.2) | 126.8 (81.1–154) | 0.4 | |
PF ratio day 10 (median, IQR) | 123.3 (87.9–162) | 132.3 (96.3–170.4) | 86.9 (75.6–148.6) | 0.038 | |
PF ratio day 15 (median, IQR) | 129.1 (90.3–172.2) | 127.7 (95.3–181.5) | 133.9 (79.3–171.5) | 0.48 |
Total (n = 178) | Fungal Infection | p-Value | ||
---|---|---|---|---|
No | Yes | |||
White blood cells | 10.3 (6.8–14.6) | 10.3 (6.6–14.7) | 9.7 (7.6–13.6) | 0.99 |
Neutrophils | 9.1 (5.5–13) | 9.1 (5.4–13.2) | 9.1 (6.6–12.3) | 0.89 |
Lymphocytes | 0.7 (0.5–1) | 0.7 (0.5–1.01) | 0.6 (0.4–1) | 0.56 |
NLR | 13.2 (8.1–23.3) | 13 (8.1–22.7) | 14.5 (7.4–25.5) | 0.53 |
Monocytes | 0.5 (0.3–0.7) | 0.5 (0.3–0.7) | 0.4 (0.2–0.6) | 0.23 |
Eosinophils | 0.01 (0–0.03) | 0.01 (0–0.03) | 0.03 (0–0.1) | 0.049 |
Platelets | 237.4 (183.8–291.3) | 238.5 (184.5–288.1) | 234 (164–310.4) | 0.94 |
Hemoglobin | 12.8 (11.4–14.1) | 12.8 (11.5–14.1) | 12.5 (10–14.5) | 0.41 |
d-dimers | 1.4 (0.7–3.2) | 1.4 (0.7–2.8) | 3 (1–3.6) | 0.09 |
Fibrinogen | 563 (461–659) | 563 (464–660) | 560 (450–610) | 0.59 |
CRP | 10.2 (5.6–16.1) | 10.5 (5.8–16.1) | 6.7 (4–17.1) | 0.12 |
Urea | 53 (41.5–70) | 53 (40–70) | 50 (45–73) | 0.5 |
Creatinine | 0.9 (0.8–1.2) | 0.9 (0.8–1.2) | 0.9 (0.7–1.3) | 0.93 |
AST | 41 (28–63) | 42 (28–68) | 36 (27–50) | 0.21 |
ALT | 44 (29–81) | 45 (29–84) | 41 (27–65) | 0.47 |
ALP | 60 (45–80) | 60 (46–80) | 52 (41–72) | 0.4 |
γGT | 59 (36–102) | 59 (34–102) | 57.5 (37–92) | 0.91 |
Albumin | 3.4 (3.1–3.6) | 3.4 (3.1–3.7) | 3.1 (2.8–3.5) | 0.026 |
LDH | 438 (344–592) | 426.5 (334–568.5) | 549 (413–592) | 0.102 |
CPK | 108.5 (55–258) | 107 (55–278) | 110 (73–204) | 0.6 |
PCT | 0.2 (0.1–0.5) | 0.2 (0.1–0.5) | 0.1 (0.06–0.3) | 0.31 |
Troponin | 21.4 (5.8–96.8) | 23.2 (6.2–120.1) | 12.2 (3.4–26.3) | 0.08 |
Ferritin | 1143.5 (705.8–1830) | 1130 (704.7–1942) | 1297 (730.8) | 0.97 |
Total (n = 178) | Fungal Infection | p-Value | |||
---|---|---|---|---|---|
Treatment | No | Yes | |||
High dose corticosteroids (n, %) | 64 (36) | 52 (32.7) | 12 (63.2) | 0.009 | |
Tocilizumab (n, %) | 39 (21.9) | 31 (19.5) | 8 (42.1) | 0.024 | |
Remdesivir (n, %) | 135 (75.8) | 118 (74.2) | 17 (89.5) | 0.17 | |
Anakinra (n, %) | 11 (6.2) | 9 (5.7) | 2 (10.5) | 0.33 | |
Monoclonal antibodies (n, %) | 40 (22.5) | 36 (22.6) | 4 (21.1) | >0.99 | |
CRRT (n, %) | 67 (37.6) | 53 (33.3) | 14 (73.7) | 0.001 | |
ECMO (n, %) | 11 (6.2) | 5 (3.1) | 6 (31.6) | <0.001 | |
Outcomes | |||||
Barotrauma (n, %) | 43 (24.2) | 30 (18.9) | 13 (68.4) | <0.001 | |
Pneumothorax (n, %) | 27 (15.2) | 18 (11.3) | 9 (47.4) | <0.001 | |
Thromboembolism (n, %) | 28 (15.7) | 22 (13.8) | 6 (31.6) | 0.05 | |
Hyperglycemia (n, %) | 83 (46.6) | 77 (48.4) | 6 (31.6) | 0.14 | |
Septic shock (n, %) | 92 (51.7) | 75 (47.2) | 17 (89.5) | <0.001 | |
Positive Culture (n, %) | Blood | 63 (35.4) | 47 (29.6) | 16 (84.2) | <0.001 |
Central line | 36 (20.2) | 26 (16.4) | 10 (52.6) | <0.001 | |
Bronchial secretions | 125 (70.2) | 107 (67.3) | 18 (94.7) | 0.015 | |
Urine | 47 (26.4) | 38 (23.9) | 9 (47.4) | 0.036 | |
Length of ICU stay (median, IQR) | 18 (8–37) | 15 (7–32) | 61 (37–97) | <0.001 | |
Length of mechanical ventilation (median, IQR) | 4 (0–19) | 4 (0–14) | 42.5 (12–78) | <0.001 |
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Koukaki, E.; Rovina, N.; Tzannis, K.; Sotiropoulou, Z.; Loverdos, K.; Koutsoukou, A.; Dimopoulos, G. Fungal Infections in the ICU during the COVID-19 Era: Descriptive and Comparative Analysis of 178 Patients. J. Fungi 2022, 8, 881. https://doi.org/10.3390/jof8080881
Koukaki E, Rovina N, Tzannis K, Sotiropoulou Z, Loverdos K, Koutsoukou A, Dimopoulos G. Fungal Infections in the ICU during the COVID-19 Era: Descriptive and Comparative Analysis of 178 Patients. Journal of Fungi. 2022; 8(8):881. https://doi.org/10.3390/jof8080881
Chicago/Turabian StyleKoukaki, Evangelia, Nikoletta Rovina, Kimon Tzannis, Zoi Sotiropoulou, Konstantinos Loverdos, Antonia Koutsoukou, and George Dimopoulos. 2022. "Fungal Infections in the ICU during the COVID-19 Era: Descriptive and Comparative Analysis of 178 Patients" Journal of Fungi 8, no. 8: 881. https://doi.org/10.3390/jof8080881