A multinational report on SARS-CoV-2 infection outcomes in people with CF and Aspergillus infection or ABPA

Journal article

Background: Aspergillus infection is known to be associated with worse respiratory outcomes in people with CF (pwCF) and is a well-recognised complication of severe SARS-CoV-2 infection. The aim of this observational cross-sectional study was to examine the association of pre-existing Aspergillus infection and/or allergic bronchopulmonary aspergillosis (ABPA) in pwCF and severity of COVID-19.

Methods: Data on SARS-CoV-2 infections in pwCF from January 2020 to June 2021 were collected by the European Cystic Fibrosis Society Patient Registry. The primary outcome was COVID-19 severity measured by hospitalisation comparing those with Aspergillus infection and/or ABPA in the 12 months preceding COVID-19 and those without.

Results: In total, 1095 pwCF were diagnosed with SARS-CoV-2 and information on pre-existing Aspergillus/ABPA status was available from 807. PwCF and SARS-CoV-2 in the Aspergillus/ABPA group (n = 153), in comparison to the non-Aspergillus/ABPA group (n = 654), were more likely to be hospitalised (adjusted OR 1.79 (1.19 to 2.85); p = 0.005) and their disease course was more likely to be complicated by sepsis (adjusted OR 7.78 (1.78 to 49.43); p = 0.008). The association with hospital admission was no longer significant after excluding patients with ABPA. Secondary analysis comparing pwCF who received antifungal treatment (n = 18), versus those who did not (n = 474) during COVID-19, showed a higher rate of hospitalisation (p < 0.001); intensive care unit admission (p < 0.001), and requirement for invasive ventilation (p < 0.001) in the antifungal treated group.

Conclusion: We show that pre-existing Aspergillus/ABPA is associated with increased rates of hospitalisation and sepsis during COVID-19 in pwCF.

Authors: Bradbury, JD; Chesshyre, E; Orenti, A; Jung, A; Warris, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Journal of Cystic Fibrosis
• Volume: 23
• Issue: 2
• Pages: 354-363
• Place of publication: Netherlands
• Publication date: 2023-11-03
• Acceptance date: 2023-10-28
• DOI: 10.1016/j.jcf.2023.10.017
• EISSN: 1873-5010
• ISSN: 1569-1993
• Pmid: 37925255
• Language: English
• Keywords: sars-cov-2; severity of illness index; registries; aspergillosis; humans; European cystic fibrosis covid project group; Europe; cross-sectional studies; Covid-19; hospitalization; cystic fibrosis; allergic bronchopulmonary