Reports of COVID-19 associated pulmonary aspergillosis (CAPA) are rising, but the associated mortality and factors affecting it are not well-characterised. We performed a systematic review including 20 peer-reviewed English language studies reporting mortality in CAPA published till 18 February 2021from PubMed, Ovid SP, Web of Science, Embase and CINHAL. The pooled mortality in CAPA was 51.2% (95% CI: 43.1–61.1, I² = 38%). The leave one out sensitivity analysis and influential case diagnostics revealed one outlier and its exclusion resulted in a mortality estimate of 54% (95% CI: 45–62). Higher odds of mortality: 2.83 (95% CI: 1.8–4.5) were seen in CAPA compared to controls. No significant difference in various subgroups according to the country of study, the continent of study, income category of country and quality of the included study was seen. None of the host risk factors, mycological test results, therapy for COVID-19 and antifungal therapy affected mortality. Thus, patients with CAPA have a high probability of mortality and early diagnosis with prompt therapy must be ensured to optimally manage these patients. However, more prospective studies with global and multi-centre coordination may help to address CAPA in a better way.

中文翻译：

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2019冠状病毒病相关肺曲霉病危重患者的死亡率：系统评价和荟萃分析

COVID-19 相关肺曲霉病 (CAPA) 的报告不断增加，但相关死亡率和影响因素尚不明确。我们进行了系统回顾，其中包括 20 项同行评审的英语语言研究，报告了截至 2021 年 2 月 18 日发布的 CAPA 死亡率，这些研究由 PubMed、Ovid SP、Web of Science、Embase 和 CINHAL 发表。CAPA 的汇总死亡率为 51.2%（95% CI：43.1–61.1，I ²  = 38%）。留一法敏感性分析和有影响力的病例诊断揭示了一个异常值，排除该异常值导致死亡率估计为 54%（95% CI：45-62）。与对照组相比，CAPA 患者的死亡率较高：2.83（95% CI：1.8-4.5）。根据研究国家、研究大陆、国家收入类别和纳入研究的质量，各个亚组没有显着差异。宿主危险因素、真菌学检测结果、COVID-19 治疗和抗真菌治疗均不影响死亡率。因此，CAPA 患者的死亡率很高，必须确保早期诊断和及时治疗，以最佳地管理这些患者。然而，更多全球和多中心协调的前瞻性研究可能有助于更好地解决 CAPA 问题。