Early fungal colonization and infection as an independent predictor of in-hospital mortality in mechanically ventilated COVID-19 patients: A nationwide target trial emulation study in Taiwan
Rattachement africain : tw, us. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
To evaluate the impact of fungal colonization and infection phenotypes and other prognostic factors on in-hospital mortality among mechanically ventilated COVID-19 patients (n = 376) admitted to ICUs during the first wave of the pandemic in Taiwan. A target trial emulation framework was used to minimize immortal time bias. Patients were matched 1:1:2 for age and gender and classified into three groups: 94 in the “Early” group (fungal colonization or infection within 10 days), 94 in the “Late” group (10–30 days), and 188 in the “No” group (no fungal colonization or infection within 30 days). In-hospital mortality and clinical outcomes were compared across groups. Patients in the “Early” group received higher cumulative corticosteroid doses, had lower PaO 2 /FiO 2 ratios, and exhibited higher rates of comorbidities, cytomegalovirus viremia, and lung, heart, and kidney complications. They also had a longer duration of ventilator use, ICU stay, and total hospitalization compared to the “Late” and “No” groups. Time-dependent multivariate Cox regression analysis identified the “Early” phenotype as a strong predictor of in-hospital mortality (adjusted hazard ratio [aHR]= 3.992, 95 % CI: 2.676–5.956, p < 0.001). Additional independent risk factors included Charlson Comorbidity Index (aHR = 1.213, 95 % CI: 1.113–1.323, p < 0.001) and APACHE II score (aHR = 1.028, 95 % CI: 1.011–1.045, p = 0.001). In contrast, higher PaO 2 /FiO 2 ratios (aHR = 0.998, 95 % CI: 0.997–1.000, p = 0.021) and ganciclovir use (aHR = 0.419, 95 % CI: 0.245–0.717, p = 0.002) were associated with reduced mortality. “Early” fungal colonization and infection within 10 days of corticosteroid initiation is an independent risk factor for in-hospital mortality in mechanically ventilated COVID-19 patients. Future research should explore early intervention strategies, including antifungal prophylaxis, optimized corticosteroid dosing, and immune modulation, to improve survival outcomes.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Early fungal colonization and infection as an independent predictor of in-hospital mortality in mechanically ventilated COVID-19 patients: A nationwide target trial emulation study in Taiwan
- Date Crossref
- 01/07/2025
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Tzu Chi University pays non établi dans la noticeUniversité ou école supérieure
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Taipei Tzu Chi Hospital Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
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National Yang Ming Chiao Tung University pays non établi dans la noticeUniversité ou école supérieure
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Taipei Veterans General Hospital pays non établi dans la noticeÉtablissement de santé
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Far Eastern Memorial Hospital pays non établi dans la noticeÉtablissement de santé
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Yuan Ze University Department of Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Taipei Medical University Hospital Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
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Taipei Medical University-Shuang Ho Hospital pays non établi dans la noticeÉtablissement de santé
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Taipei Medical University pays non établi dans la noticeUniversité ou école supérieure
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National Taiwan University Hospital Department of Internal Medicine pays non établi dans la noticeÉtablissement de santé
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Chang Gung Memorial Hospital Department of Thoracic Medicine pays non établi dans la noticeÉtablissement de santé
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Linkou Chang Gung Memorial Hospital pays non établi dans la noticeÉtablissement de santé
Tzu Chi University, Department of Internal Medicine — Taipei Tzu Chi Hospital et National Yang Ming Chiao Tung University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.