Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Laboratory Medicine, Catholic Genetic Laboratory Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2021 Dec 14;16(12):e0260741. doi: 10.1371/journal.pone.0260741. eCollection 2021.
The clinical significance of upper airway respiratory virus (RV) detection in patients with hematologic malignancies remains unclear. We aimed to investigate the association between upper airway RV detection and prognosis in critically ill patients with hematologic malignancies.
This retrospective observational study included 331 critically ill patients with hematologic malignancies who presented respiratory symptoms and their nasopharyngeal swab was tested using a multiplex PCR assay between January 2017 and December 2018. A logistic regression model was used to adjust for potential confounding factors in the association between assay positivity and in-hospital mortality.
Among the 331 analyzed patients, RVs were detected in 29.0%. The overall mortality rates in the intensive care unit and hospital were 56.8% and 65.9%, respectively. Positive upper airway RV detection was associated with relapsed hematologic malignancies, higher level of C-reactive protein, and prior use of high dose steroids and anti-cancer chemotherapeutic drugs. Furthermore, it was independently associated with in-hospital mortality (adjusted odds ratio, 2.36; 95% confidence interval, 1.23 to 4.54). Among different RVs, parainfluenza virus was more prevalent among patients who died in the hospital than among those who survived (11.5% vs. 3.5%, P = 0.027).
RV detection in the upper respiratory tract was relatively common in our cohort and was significantly associated with a poor prognosis. Thus, it can be used as a predictor of prognosis. Moreover, RV presence in the upper respiratory tract should be examined in patients who have previously been prescribed with high dose corticosteroids and anti-cancer drugs.
上呼吸道呼吸病毒（RV）在血液恶性肿瘤患者中的临床意义尚不清楚。我们旨在研究重症血液恶性肿瘤患者上呼吸道 RV 检测与预后的关系。
本回顾性观察性研究纳入了 2017 年 1 月至 2018 年 12 月期间出现呼吸症状且鼻咽拭子采用多重 PCR 检测的 331 例重症血液恶性肿瘤患者。采用逻辑回归模型调整检测阳性与院内死亡率之间的潜在混杂因素。
在 331 例分析患者中，29.0%检测到 RV。重症监护病房和医院的总死亡率分别为 56.8%和 65.9%。上呼吸道 RV 检测阳性与血液恶性肿瘤复发、C 反应蛋白水平升高、以及大剂量类固醇和抗癌化疗药物的使用有关。此外，它与院内死亡率独立相关（调整后的优势比，2.36；95%置信区间，1.23 至 4.54）。在不同的 RV 中，副流感病毒在医院死亡的患者中比在存活的患者中更为常见（11.5%比 3.5%，P = 0.027）。
在我们的队列中，上呼吸道 RV 检测相对常见，与预后不良显著相关。因此，它可用作预后的预测因子。此外，在上呼吸道存在 RV 时，应检查先前使用大剂量皮质类固醇和抗癌药物的患者。
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