Critically ill patients with coronavirus disease 2019 (COVID-19) may develop COVID-19-associated pulmonary aspergillosis (CAPA), that impact their chances of survival. Whether positive bronchoalveolar lavage fluid (BALF) mycological tests can be used as a survival proxy remains unknown. We conducted a post-hoc analysis of a previous multicenter, multinational observational study with the aim of assessing the differential prognostic impact of BALF mycological tests, namely positive (≥ 1.0 optical density index) BALF galactomannan (GM) and positive BALF Aspergillus culture alone or in combination in critically ill patients with COVID-19. Of the 592 patients critically ill patients with COVID-19 enrolled in the main study, 218 were included in this post-hoc analysis as they had both test results available. CAPA was diagnosed in 56/218 patients (26%). Most cases were probable CAPA (51/56, 91%) and fewer were proven CAPA (5/56, 9%). In the final multivariable model adjusted for between-center heterogeneity, an independent association with 90-day mortality was observed for the combination of positive BALF GM and positive BALF Aspergillus culture in comparison with both tests negative (hazard ratio 2.53, 95% CI 1.28-5.02, p = 0.008). The other independent predictors of 90-day mortality were increasing age and active malignant disease. In conclusion, the combination of positive BALF GM and positive BALF Aspergillus culture was associated with increased 90-day mortality in critically ill patients with COVID-19. Additional study is needed to explore the possible prognostic value of other BALF markers.
Key words: CAPA; GM; biomarker; galactomannan; Aspergillus; COVID-19; BALF.