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Cited by 80Respiratory viral infections researchNosocomial Infections in ICUNeutropenia and Cancer Infections

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Clinical Significance of Upper Airway Virus Detection in Critically Ill Hematology Patients

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Legoff, Jérôme, Zucman, Noémie, Lemiale, Virginie, Mokart, Djamel, Pène, Frédéric, Lambert, Jérôme, Kouatchet, Achille, Demoule, Alexandre, Vincent, François, Nyunga, Martine, Bruneel, Fabrice, Contejean, Adrien, Mercier-Delarue, Séverine, Rabbat, Antoine, Lebert, Christine, Perez, Pierre, Meert, Anne-Pascale, Benoit, Dominique, Schwebel, Carole, Jourdain, Mercé, Darmon, Michael, Resche-Rigon, Matthieu, Azoulay, Elie·2019·American Journal of Respiratory and Critical Care Medicine
DOI 10.1164/rccm.201804-0681oc
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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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  • Among undifferentiated patients with pneumonia or sepsis, broad-spectrum regimens including agents active against MRSA were associated with higher mortality, particularly among patients without MRSA.

    “Among undifferentiated patients with pneumonia or sepsis, broad-spectrum regimens including agents active against MRSA were associated with higher mortality, particularly among patients without MRSA (137,151,155,156).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [155]

    The Results section on patients with acute respiratory failure reports mortality by respiratory-virus detection and says antibiotic use did not differ significantly between virus-positive and virus-negative patients (page unavailable). Searches for MRSA, broad-spectrum regimens, and antibiotic-associated mortality found no passage addressing the claimed association in patients with pneumonia or sepsis. (LLM, conf=0.78)

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Metadata

Authors
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, A.-P., Benoit, D., Schwebel, C., Jourdain, M., Darmon, M., Resche-Rigon, M., & Azoulay, E.
Affiliations
  • Assistance Publique – Hôpitaux de Paris (FR)
  • Institut Paoli-Calmettes (FR)
  • Hôpital Cochin (FR)
  • Centre Hospitalier Universitaire d'Angers (FR)
  • Sorbonne Université (FR)
  • Centre Hospitalier de Roubaix (FR)
  • Centre Hospitalier de Versailles (FR)
  • Virology Department
  • Centre Hospitalier Départemental Vendée (FR)
  • Intensive Care Unit, Brabois Teaching Hospital, Nancy, France
  • Institut Jules Bordet (BE)
  • Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
  • Centre Hospitalier Universitaire de Grenoble (FR)
  • Centre Hospitalier Universitaire de Lille (FR)
  • Intensive Care Unit, and
  • Statistics Department, AP-HP, Saint Louis Teaching Hospital, Paris, France
  • Intensive Care Unit
ORCID
Venue
American Journal of Respiratory and Critical Care Medicine
Publisher
Oxford University Press (OUP)
Published
2019-02
Volume
199
Issue
4
Pages
518-528
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
DOI
10.1164/rccm.201804-0681oc
OpenAlex
W2890642667
Cited by
80
References
1
Citations by year
2026: 6 · 2025: 10 · 2024: 10 · 2023: 11 · 2022: 13 · 2021: 8 · 2020: 17 · 2019: 4
FWCI
5.88
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Respiratory and Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, other-oa)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
Funders
French Ministry of Health and French Intensive Care Society (PHRC AOM 08235)
Topics
  • Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
Keywords
respiratory virus detection, ICU mortality, acute respiratory failure, multiplex PCR, nasopharyngeal swab, influenza, parainfluenza virus, respiratory syncytial virus, rhinovirus, enterovirus, immunocompromised patients, hematopoietic stem cell transplantation, lymphoproliferative disorders, immunosuppression, risk stratification
MeSH terms
Aged, Female, Hematologic Diseases, Humans, Influenza, Human, Intensive Care Units, Male, Middle Aged, Picornaviridae Infections, Respiratory Tract Infections, Critical Illness, Immunocompromised Host, Hospital Mortality, Paramyxoviridae Infections, Respiratory Syncytial Virus Infections, Multiplex Polymerase Chain Reaction

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