Dumas Guillaume, Bertrand Maxime, Lemiale Virginie, Canet Emmanuel, Barbier François, Kouatchet Achille, Demoule Alexandre, Klouche Kada, Moreau Anne-Sophie, Argaud Laurent, Wallet Florent, Raphalen Jean-Herlé, Mokart Djamel, Bruneel Fabrice, Pène Frédéric, Azoulay Elie
Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes; Université Grenoble-Alpes, INSERM U1300-HP2, Grenoble, France.
Medical Intensive Care Unit, Saint-Louis Teaching Hospital, AP-HP, Paris, France.
Ann Intensive Care. 2023 Oct 13;13(1):101. doi: 10.1186/s13613-023-01196-9.
Acute 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.
Of 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]).
In 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.
急性呼吸衰竭（ARF）是重症监护病房（ICU）收治患者的主要原因。病毒越来越被认为是免疫功能低下患者肺炎的病因，但流行病学数据稀缺。我们使用肿瘤血液学呼吸复苏研究小组的数据库（2003 - 2017年，72个重症监护病房）来描述病毒检测呈阳性的急性呼吸衰竭免疫功能低下重症患者的情况，并报告其预后。然后，根据临床特征和严重程度（1:3比例），将病毒检测呈阳性的急性呼吸衰竭患者与其他病因导致的急性呼吸衰竭患者进行匹配。
在整个队列的4038例免疫功能低下患者中，370例（9.2%）诊断为病毒检测呈阳性的急性呼吸衰竭，并纳入研究。流感是最常见的病毒（59%），其次是呼吸道合胞病毒（14%），有明显的季节性变化。79例患者（21%）发现有合并细菌感染，23例患者（6%）发现有侵袭性肺曲霉病。粗住院死亡率为37.8%。与死亡率相关的因素有：中性粒细胞减少（比值比[OR]=1.74，95%置信区间[CI][1.05 - 2.89]）、身体状况差（OR = 1.84，CI [1.12 - 3.03]）以及入院当天需要有创机械通气（OR = 1.97，CI [1.14 - 3.40]）。病毒类型与死亡率无关。匹配后，病毒检测呈阳性的急性呼吸衰竭患者的死亡率低于其他病因导致的急性呼吸衰竭患者（OR = 0.77，CI [0.60 - 0.98]）。这一结果主要由流感样病毒驱动，即呼吸道合胞病毒、副流感病毒和人偏肺病毒（OR = 0.54，CI [0.33 - 0.88]）。
在病毒检测呈阳性的急性呼吸衰竭免疫功能低下患者中，无论病毒种类如何，死亡率都很高，主要受临床严重程度和总体状况差的影响。然而，与非病毒所致急性呼吸衰竭相比，住院死亡率较低，尤其是对于检测到除流感以外病毒的患者。
