Prognosis of critically ill immunocompromised patients with virus-detected acute respiratory failure

Annals of Intensive Care

Research

Jean-Herlé Raphalen¹  Djamel Mokart²  Florent Wallet³  Fabrice Bruneel⁴  Achille Kouatchet⁵  Kada Klouche⁶  Frédéric Pène⁷  Laurent Argaud⁸  François Barbier⁹  Maxime Bertrand^1,10  Virginie Lemiale^1,10  Elie Azoulay^1,10  Emmanuel Canet^1,11  Alexandre Demoule^1,12  Guillaume Dumas^1,13  Anne-Sophie Moreau^1,14 

[1] Department of Anesthesia and Critical Care, Necker Hospital, Paris, France;Intensive Care Unit, Institut Paoli Calmettes, Marseille, France;Intensive Care Unit, Lyon Sud Medical Center, Lyon, France;Medical Intensive Care Unit, Andre Mignot Hospital, Versailles, France;Medical Intensive Care Unit, Angers Teaching Hospital, Angers, France;Medical Intensive Care Unit, CHU de Montpellier, Montpellier, France;Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France;Institut Cochin, INSERM Unité 1016/Centre National de La Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 8104/Université de Paris, Paris, France;Medical Intensive Care Unit, Hospices Civils de Lyon, Hopital Edouard Herriot, Lyon, France;Medical Intensive Care Unit, La Source Hospital, CHR Orleans, Orleans, France;Medical Intensive Care Unit, Saint-Louis Teaching Hospital, AP-HP, Paris, France;ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France;Nantes Université, CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France;Service de Médecine Intensive et Réanimation (Département R3S), Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, and AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France;Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes; Université Grenoble-Alpes, INSERM U1300-HP2, Grenoble, France;Service de Réanimation Polyvalente, CHRU de Lille - Hôpital Roger Salengro, Lille, France;

关键词: Immunocompromised;    Respiratory virus;    Influenza;    Pneumonia;    Mechanical ventilation;   

DOI  :  10.1186/s13613-023-01196-9

 received in 2023-07-07, accepted in 2023-09-26,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAcute respiratory failure (ARF) is the leading cause of ICU admission. Viruses are increasingly recognized as a cause of pneumonia in immunocompromised patients, but epidemiologic data are scarce. We used the Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie’s database (2003–2017, 72 intensive care units) to describe the spectrum of critically ill immunocompromised patients with virus-detected ARF and to report their outcomes. Then, patients with virus-detected ARF were matched based on clinical characteristics and severity (1:3 ratio) with patients with ARF from other origins.ResultsOf the 4038 immunocompromised patients in the whole cohort, 370 (9.2%) had a diagnosis of virus-detected ARF and were included in the study. Influenza was the most common virus (59%), followed by respiratory syncytial virus (14%), with significant seasonal variation. An associated bacterial infection was identified in 79 patients (21%) and an invasive pulmonary aspergillosis in 23 patients (6%). The crude in-hospital mortality rate was 37.8%. Factors associated with mortality were: neutropenia (OR = 1.74, 95% confidence interval, CI [1.05–2.89]), poor performance status (OR = 1.84, CI [1.12–3.03]), and the need for invasive mechanical ventilation on the day of admission (OR = 1.97, CI [1.14–3.40]). The type of virus was not associated with mortality. After matching, patients with virus-detected ARF had lower mortality (OR = 0.77, CI [0.60–0.98]) than patients with ARF from other causes. This result was mostly driven by influenza-like viruses, namely, respiratory syncytial virus, parainfluenza virus, and human metapneumovirus (OR = 0.54, CI [0.33–0.88]).ConclusionsIn immunocompromised patients with virus-detected ARF, mortality is high, whatever the species, mainly influenced by clinical severity and poor general status. However, compared to non-viral ARF, in-hospital mortality was lower, especially for patients with detected viruses other than influenza.

【 授权许可】

CC BY   
© La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF) 2023

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