ABSTRACT
OBJECTIVE: To systematically describe the outcomes of patients with COVID-19-associated pulmonary aspergillosis (CAPA). METHODS: All of the researches covering the clinical outcomes of CAPA were retrieved from databases such as ScienceDirect, PubMed, CNKI and MEDLINE (OVID) from Dec 31, 2019 to Dec 1, 2021. The literatures were screened out based on inclusion and exclusion criteria by 2 writers, the data were extracted, the quality of the literatures was evaluated, and meta-analysis was performed. RESULTS: Totally 14 cohort studies were included in this study, with 2 056 severe COVID-19 patients involved, including 338 CAPA patients and 1 718 non-CAPA patients. The incidence rate of CAPA was 16.4% among the ICU patients. As compared with the non-CAPA patients, the mortality rate of the CAPA patients was increased by 21% [risk difference (RD)]=0.21, 95% CI:0.15-0.27, (I-2=0%). No heterogeneity or publication bias was detected (t=1.98, P=0.069). Among the patients with underlying diseases, the patients with chronic obstructive pulmonary disease (COPD) were 2.37 times the risk of CAPA as high as the patients of the non-CAPA group (95% CI: 1.15-4.88, P=0.020). The creatinine level of the CAPA patients was higher than that of the non-CAPA patients (33.32 micro mol/L, 95% CI: 6.81-59.83, P=0.014). As compared with the non-CAPA patients, the patients who received renal replacement therapy were 2.33 times the risk of CAPA (95% CI: 1.43-3.80, P=0.001). CONCLUSION: 16.4% of the severe COVID-19 patients have CAPA, the mortality rate is high. COPD, serum creatinine and renal replacement therapy may remarkably increase the risk of CAPA, and it is suggested that a prospective screening of CAPA should be carried out for the severe COVID-19 patients.