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
Year: 2025
Type: article
Study design: Observational Study
Abstract: Purpose 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. Materials and methods 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. Results 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. Conclusions “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.
Authors: Yao-Kuang Wu, Hsueh-Wen Chung, Wei-Chih Chen, Kuang-Yao Yang, Lun-Yu Jao, Hou-Tai Chang, Chien-Hua Tseng, Tzu-Tao Chen, Shih-Chi Ku, Thomas Tao-Min Huang, Tzu-Hsuan Chiu, Kuo-Chin Kao, Chieh-Jen Wang, Chiao-Hung Wang, Tse-Bin Yang, Chi-Won Suk, Chung-Kan Peng, Chih-Hao Shen, Yu-San Chien, Li-kuo Kuo, Chen-Chun Lin, Chia-Mo Lin, Wei-Lun Liu, Huang-Pin Wu, Ming-Huang Chiu, Ming-Cheng Chan, Chieh-Mo Lin, Chung-Shu Lee, Chia-Hao Chang, Li-Ta Keng, Hsing-Chun Chen, Yi-Ting Chen, Shih-Chieh Chang, Yi-Chun Lai, Chin-Ming Chen, Wen-Feng Fang, Wen-Lin Su
Institutions: Tzu Chi University, Tzu Chi Foundation, Taipei Tzu Chi Hospital, National Yang Ming Chiao Tung University, Taipei Veterans General Hospital, Far Eastern Memorial Hospital, Yuan Ze University, Taipei Medical University-Shuang Ho Hospital, Taipei Medical University, National Taiwan University, National Taiwan University Hospital, Chang Gung Memorial Hospital, Taoyuan Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Chang Gung University, Mackay Memorial Hospital, Taipei City Hospital, Wan Fang Hospital, Tri-Service General Hospital, Mackay Medical University, Chiayi Chang Gung Memorial Hospital, Shin Kong WHS Memorial Hospital, Fu Jen Catholic University, Keelung Chang Gung Memorial Hospital, Cathay General Hospital, National Chung Hsing University, Taichung Veterans General Hospital, Dalin Tzu Chi Hospital, Hualien Tzu Chi Medical Center, National Yang Ming University Hospital, Chi Mei Medical Center, Chang Gung University of Science and Technology, Kaohsiung Chang Gung Memorial Hospital
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,310
Awards: G1741605567, G1856561283, G6014256975
OpenAlex ID: W4409259017