Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris.
Service de Virologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris.
Chest. 2023 Dec;164(6):1364-1377. doi: 10.1016/j.chest.2023.07.4222. Epub 2023 Aug 9.
In immunocompromised patients with acute respiratory failure (ARF), the clinical significance of respiratory virus detection in the nasopharynx remains uncertain.
Is viral detection in nasopharyngeal swabs associated with causes and outcomes of ARF in immunocompromised patients?
This preplanned post hoc analysis of a randomized controlled trial enrolled immunocompromised patients admitted to 32 ICUs for ARF between May 2016 and December 2017. Nasopharyngeal swabs sampled at inclusion were assessed for 23 respiratory pathogens using multiplex polymerase chain reaction (PCR) assay. Causes of ARF were established by managing physicians and were reviewed by three expert investigators masked to the multiplex PCR assay results. Associations between virus detection in nasopharyngeal swabs, causes of ARF, and composite outcome of day 28 mortality, invasive mechanical ventilation (IMV), or both were assessed.
Among the 510 sampled patients, the multiplex PCR assay results were positive in 103 patients (20.2%), and a virus was detected in 102 samples: rhinoviruses or enteroviruses in 35.5%, coronaviruses in 10.9%, and flu-like viruses (influenza virus, parainfluenza virus, respiratory syncytial virus, human metapneumovirus) in 52.7%. The cause of ARF varied significantly according to the results of the multiplex PCR assay, especially the proportion of viral pneumonia: 50.0% with flu-like viruses, 14.0% with other viruses, and 3.6% when no virus was detected (P < .001). No difference was found in the composite outcome of day 28 mortality, IMV, or both according to positive assay findings (54.9% vs 54.7%; P = .965). In a pre-established subgroup analysis, flu-like virus detection was associated with a higher rate of day 28 mortality, IMV, or both among recipients of allogeneic hematopoietic stem cell transplantation compared with those without detected virus.
In immunocompromised patients with ARF, the results of nasopharyngeal multiplex PCR assays are not associated with IMV or mortality. A final diagnosis of viral pneumonia is retained in one-third of patients with positive assay results and in one-half of the patients with a flu-like virus.
在患有急性呼吸衰竭（ARF）的免疫功能低下患者中，鼻咽部呼吸道病毒检测的临床意义尚不确定。
鼻咽拭子中病毒的检测是否与免疫功能低下患者 ARF 的病因和结局相关？
这是一项对 2016 年 5 月至 2017 年 12 月期间因 ARF 入住 32 个 ICU 的免疫功能低下患者进行的随机对照试验的预设事后分析。在纳入时采集鼻咽拭子样本，使用多重聚合酶链反应（PCR）检测 23 种呼吸道病原体。由主治医生确定 ARF 的病因，并由 3 位专家调查员对多重 PCR 检测结果进行盲法评估。评估鼻咽拭子中病毒的检测、ARF 的病因与 28 天死亡率、有创机械通气（IMV）或两者均复合的结局之间的关系。
在 510 例采样患者中，103 例（20.2%）多重 PCR 检测结果阳性，102 例样本中检测到病毒：鼻病毒或肠道病毒 35.5%、冠状病毒 10.9%、流感样病毒（流感病毒、副流感病毒、呼吸道合胞病毒、人偏肺病毒）52.7%。ARF 的病因根据多重 PCR 检测结果差异显著，尤其是病毒性肺炎的比例：流感样病毒 50.0%、其他病毒 14.0%、未检测到病毒 3.6%（P<0.001）。根据阳性检测结果，28 天死亡率、IMV 或两者的复合结局无差异（54.9%与 54.7%；P=0.965）。在预先设定的亚组分析中，与未检测到病毒的患者相比，同种异体造血干细胞移植受者中流感样病毒的检测与 28 天死亡率、IMV 或两者的发生率更高相关。
在患有 ARF 的免疫功能低下患者中，鼻咽部多重 PCR 检测结果与 IMV 或死亡率无关。在检测结果阳性的患者中，三分之一的患者保留病毒性肺炎的最终诊断，而在流感样病毒检测阳性的患者中，有一半的患者保留该诊断。
