Table 1.
Clinical Characteristics of 44 Patients Critically Ill with Viral Pneumonia in the Autopsy Cohort
| Autopsy Cohort | Total (n = 44) | Antemortem Probable VAPA (n = 21) | Antemortem No Suspicion of VAPA (n = 23) |
|---|---|---|---|
| Baseline characteristics | |||
| Mean age (SD), yr | 65 (12) | 67 (9) | 64 (15) |
| Male sex | 29 (66) | 13 (62) | 16 (70) |
| BMI > 30 kg/m2 | 11 (25) | 3 (14) | 8 (35) |
| Diabetes mellitus | 11 (25) | 6 (29) | 5 (22) |
| Liver cirrhosis | 2 (5) | 2 (10) | 0 (0) |
| COPD | 5 (11) | 5 (24) | 0 (0) |
| Interstitial lung disease | 3 (7) | 2 (10) | 1 (4) |
| Smoking | 6 (14) | 2 (10) | 4 (17) |
| EORTC/MSGERC host factor | 12 (27) | 7 (33) | 5 (22) |
| CS EORTC/MSGERC criterium | 4 (9) | 3 (14) | 1 (4) |
| Hematological malignancy | 3 (7) | 2 (10) | 1 (4) |
| Immunosuppressive therapy | 12 (27) | 7 (33) | 5 (22) |
| Neutropenia | 1 (2) | 1 (5) | 0 (0) |
| Solid organ transplantation | 4 (9) | 3 (14) | 1 (4) |
| Systemic CS 30 d before ICU admission | 21 (48) | 12 (57) | 9 (39) |
| Median dose systemic CS 30 d before ICU admission* | 0.10 (0.03 to 0.33) (n = 21) | 0.10 (0.04 to 0.56) (n = 12) | 0.10 (0.02 to 0.23) (n = 9) |
| Viral disease | |||
| Influenza | 21 (48) | 9 (43) | 12 (52) |
| COVID-19 | 23 (52) | 12 (57) | 11 (48) |
| ICU stay characteristics | |||
| Mean APACHE II score on admission (SD) | 22 (7) (n = 30) | 22 (8) (n = 16) | 23 (6) (n = 14) |
| Duration between viral symptom onset and ICU admission, d | 6 (3 to 10) (n = 41) | 8 (2 to 10) (n = 19) | 6 (4 to 8) (n = 22) |
| Invasive ventilator support | 42 (95) | 20 (95) | 22 (96) |
| Nitric oxide inhalation | 16 (36) | 8 (38) | 8 (35) |
| Prone ventilation | 23 (52) | 13 (62) | 10 (43) |
| ECMO | 11 (25) | 2 (10) | 9 (39) |
| Duration of noninvasive ventilation,† d | 4 (2 to 7) (n = 35) | 4 (1 to 8) (n = 18) | 4 (3 to 8) (n = 17) |
| Duration of invasive ventilation, d | 20 (9 to 27) (n = 42) | 21 (10 to 31) (n = 21) | 16 (8 to 26) (n = 21) |
| Vasopressor therapy | 40 (91) | 17 (81) | 23 (100) |
| Renal replacement therapy | 19 (43) | 9 (43) | 10 (43) |
| Systemic CS during ICU stay | 43 (98) | 21 (100) | 22 (96) |
| Median dose systemic CS during ICU* | 0.60 (0.40 to 1.00) (n = 43) | 0.60 (0.35 to 0.92) (n = 21) | 0.70 (0.38 to 1.00) (n = 22) |
| Tocilizumab | 1 (2) | 1 (5) | 0 (0) |
| ICU length of stay, d | 22 (11 to 32) | 21 (13 to 44) | 22 (10 to 30) |
| Antemortem suspicion of aspergillosis | |||
| Serum GM testing | |||
| Performed | 28 (64) | 17 (81) | 11 (48) |
| Time between first sampling and ICU admission, d | 5 (1 to 10) (n = 28) | 7 (4 to 12) (n = 17) | 2 (0 to 2) (n = 11) |
| BAL GM testing | |||
| Performed | 40 (91) | 20 (95) | 20 (87) |
| Time between first sampling and ICU admission, d | 5 (2 to 11) (n = 40) | 5 (2 to 10) (n = 20) | 4 (−1 to 11) (n = 20) |
| Fungal culture | |||
| Bronchial aspirate fungal culture performed | 23 (52) | 14 (67) | 9 (39) |
| BAL fungal culture performed | 39 (89) | 20 (95) | 19 (83) |
| CT thorax | |||
| Performed | 36 (82) | 19 (90) | 17 (74) |
| Time between first CT thorax and ICU admission, d | 0 (−2 to 17) (n = 36) | 0 (−1 to 22) (n = 19) | 0 (−3 to 16) (n = 17) |
| Histology | |||
| Time between viral symptom onset and histology, d | 29 (17 to 42) (n = 41) | 30 (19 to 51) (n = 19) | 25 (14 to 41) (n = 22) |
| Histological evidence of IPA (all forms) | 12 (27) | 11 (52) | 1 (4) |
Definition of abbreviations: APACHE II = acute physiology and chronic health evaluation II; BMI = body mass index; COPD = chronic obstructive pulmonary disease; CS = corticosteroids; CT = computed tomography; ECMO = extracorporeal membrane oxygenation; EORTC = European Organization for Research and Treatment of Cancer; GM = galactomannan; IPA = invasive pulmonary aspergillosis; MSGERC = Mycoses Study Group Education and Research Consortium; VAPA = viral-associated pulmonary aspergillosis.
Data are number (percentage) or median (interquartile range) unless otherwise specified.
Corticosteroid dose is expressed as mean dose in mg/kg/d of prednisone equivalent.
Noninvasive ventilation includes high-flow nasal oxygen therapy and noninvasive bilevel positive airway pressure/continuous positive airway pressure via face mask.