• Jérôme Legoff, Noémie Zucman, Virginie Lemiale, Djamel Mokart, Frédéric Pène, Jérôme Lambert, Achille Kouatchet, Alexandre Demoule, François Vincent, Martine Nyunga, Fabrice Bruneel, Adrien Contejean, Séverine Mercier-Delarue, Antoine Rabbat, Christine Lebert, Pierre Perez, Anne-Pascale Meert, Dominique Benoit, Carole Schwebel, Mercé Jourdain, Michael Darmon, Matthieu Resche-Rigon, and Elie Azoulay.
• 1 Virology Department.
• Am. J. Respir. Crit. Care Med. 2019 Feb 15; 199 (4): 518-528.

RationaleNoninvasive diagnostic multiplex molecular tests may enable the early identification and treatment of viral infections in critically ill immunocompromised patients.ObjectivesTo assess the association between viral detection in nasopharyngeal swabs and ICU mortality in critically ill hematology patients.MethodsThis 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 ResultsOf 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).ConclusionsRespiratory 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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