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Legoff J, Zucman N, Lemiale V, Mokart D, Pène F, Lambert J, Kouatchet A, Demoule A, Vincent F, Nyunga M, Bruneel F, Contejean A, Mercier-Delarue S, Rabbat A, Lebert C, Perez P, Meert AP, Benoit D, Schwebel C, Jourdain M, Darmon M, Resche-Rigon M, Azoulay E. Clinical Significance of Upper Airway Virus Detection in Critically Ill Hematology Patients. Am J Respir Crit Care Med 2020; 199:518-528. [PMID: 30230909 DOI: 10.1164/rccm.201804-0681oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Noninvasive diagnostic multiplex molecular tests may enable the early identification and treatment of viral infections in critically ill immunocompromised patients. OBJECTIVES To assess the association between viral detection in nasopharyngeal swabs and ICU mortality in critically ill hematology patients. METHODS This was a post hoc analysis of a prospective cohort of critically ill hematology patients admitted to 17 ICUs. Nasal swabs sampled and frozen at ICU admission were tested using a multiplex PCR assay. Predictors of ICU mortality and assay positivity were identified. MEASUREMENTS AND MAIN RESULTS Of the 747 patients (447 with acute respiratory failure [ARF]), 21.3% had a virus detected (56.4% rhinovirus/enterovirus and 30.7% influenza/parainfluenza/respiratory syncytial viruses). Overall ICU and hospital mortality rates were 26% and 37%, respectively. Assay positivity was associated with lymphoproliferative disorders, hematopoietic stem cell transplantation, treatment with steroids or other immunosuppressants, ARF (25.5% vs. 16.3%; P = 0.004), and death in the ICU (28.9% vs. 19.3%; P = 0.008). The association with ICU mortality was significant for all viruses and was strongest for influenza/parainfluenza/respiratory syncytial viruses. In patients with ARF, detection of any respiratory virus was independently associated with ICU mortality (odds ratio, 2.07; 95% confidence interval, 1.22-3.50). CONCLUSIONS Respiratory virus detection in the upper airway by multiplex PCR assay is common in critically ill hematology patients. In patients with ARF, respiratory virus detection was independently associated with ICU mortality. Multiplex PCR assay may prove helpful for the risk stratification of hematology patients with ARF. Studies to understand whether respiratory tract viruses play a causal role in outcomes are warranted.
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Affiliation(s)
| | | | | | - Djamel Mokart
- 3 Intensive Care Unit, Paoli Calmette Institute, Marseille, France
| | - Frédéric Pène
- 4 Intensive Care Unit, AP-HP, Cochin Teaching Hospital, Paris, France
| | - Jérôme Lambert
- 5 Statistics Department, AP-HP, Saint Louis Teaching Hospital, Paris, France
| | | | - Alexandre Demoule
- 7 Intensive Care Unit, AP-HP, Pitié Salpêtrière Teaching Hospital, Paris, France
| | - François Vincent
- 8 Intensive Care Unit, AP-HP, Avicennes Teaching Hospital, Bobigny, France
| | - Martine Nyunga
- 9 Intensive Care Unit, Roubaix Regional Hospital Center, Roubaix, France
| | - Fabrice Bruneel
- 10 Intensive Care Unit, Versailles Teaching Hospital, Le Chesnay, France
| | | | | | - Antoine Rabbat
- 4 Intensive Care Unit, AP-HP, Cochin Teaching Hospital, Paris, France
| | - Christine Lebert
- 11 Intensive Care Unit, District Hospital Center, La Roche sur Yon, France
| | - Pierre Perez
- 12 Intensive Care Unit, Brabois Teaching Hospital, Nancy, France
| | | | - Dominique Benoit
- 14 Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Carole Schwebel
- 15 Intensive Care Unit, Grenoble Teaching Hospital, Grenoble, France; and
| | - Mercé Jourdain
- 16 Intensive Care Unit, Regional Teaching Hospital, Lille, France
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