OBJECTIVE  To explore the clinical characteristics of patients with COVID-19-associated pulmonary aspergillosis (CAPA) among those with acute respiratory distress syndrome (ARDS) and to analyze the risk factors for CAPA.

METHODS  A total of 117 patients with ARDS admitted to Peking University People′s Hospital from Dec. 1, 2022 to Jan. 31, 2023 were selected. Based on the diagnostic criteria for CAPA, patients were divided into the CAPA group (n=13) and the non-CAPA group (n=104). Clinical characteristics of CAPA patients were analyzed, and risk factors were summarized by multivariate logistic regression analysis.

RESULTS  Compared with non-CAPA patients, a high proportion of CAPA paitents had a low oxygenation index at admission (< 200 mmHg: 61.54% vs. 39.42%), those required more invasive respiratory support (ventilator and ECMO: 38.46% vs. 5.77%), and had a glucocorticoid treatment duration >10 days (76.92% vs. 16.35%). CAPA patients also received more treatments such as tocilizumab (38.46% vs. 11.54%) and antiviral drugs (92.31% vs. 50.00%), had longer hospital stays (24.00 vs. 16.00 days) and a higher in-hospital mortality rate (69.23% vs. 21.15%). The use of invasive mechanical ventilation/ECMO during hospitalization (OR=11.386, P=0.013) and therapeutic doses of glucocorticoids for >10 days (OR=15.671, P < 0.001) were risk factors for CAPA in patients with ARDS.

CONCLUSIONS  Among COVID-19 patients with ARDS, CAPA patients receive more therapeutic drugs and treatments during hospitalization. CAPA is associated with the use of invasive mechanical ventilation or ECMO and prolonged use of therapeutic doses of glucocorticoids during hospitalization.