SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients.
Aged
Betacoronavirus
/ isolation & purification
COVID-19
Coronavirus Infections
/ diagnosis
Critical Illness
/ mortality
Female
France
/ epidemiology
Humans
Male
Middle Aged
Pandemics
Pneumonia, Viral
/ diagnosis
Prospective Studies
Respiration, Artificial
Respiratory Distress Syndrome
/ therapy
Respiratory System
/ virology
SARS-CoV-2
Switzerland
/ epidemiology
Viral Load
Virus Shedding
COVID-19
ICU
Lower respiratory tract
Mortality
SARS-CoV-2
Viral load
Viral shedding
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
16 10 2020
16 10 2020
Historique:
received:
19
08
2020
accepted:
04
10
2020
entrez:
17
10
2020
pubmed:
18
10
2020
medline:
22
10
2020
Statut:
epublish
Résumé
Data on SARS-CoV-2 load in lower respiratory tract (LRT) are scarce. Our objectives were to describe the viral shedding and the viral load in LRT and to determine their association with mortality in critically ill COVID-19 patients. We conducted a binational study merging prospectively collected data from two COVID-19 reference centers in France and Switzerland. First, we described the viral shedding duration (i.e., time to negativity) in LRT samples. Second, we analyzed viral load in LRT samples. Third, we assessed the association between viral presence in LRT and mortality using mixed-effect logistic models for clustered data adjusting for the time between symptoms' onset and date of sampling. From March to May 2020, 267 LRT samples were performed in 90 patients from both centers. The median time to negativity was 29 (IQR 23; 34) days. Prolonged viral shedding was not associated with age, gender, cardiac comorbidities, diabetes, immunosuppression, corticosteroids use, or antiviral therapy. The LRT viral load tended to be higher in non-survivors. This difference was statistically significant after adjusting for the time interval between onset of symptoms and date of sampling (OR 3.78, 95% CI 1.13-12.64, p = 0.03). The viral shedding in LRT lasted almost 30 days in median in critically ill patients, and the viral load in the LRT was associated with the 6-week mortality.
Sections du résumé
BACKGROUND
Data on SARS-CoV-2 load in lower respiratory tract (LRT) are scarce. Our objectives were to describe the viral shedding and the viral load in LRT and to determine their association with mortality in critically ill COVID-19 patients.
METHODS
We conducted a binational study merging prospectively collected data from two COVID-19 reference centers in France and Switzerland. First, we described the viral shedding duration (i.e., time to negativity) in LRT samples. Second, we analyzed viral load in LRT samples. Third, we assessed the association between viral presence in LRT and mortality using mixed-effect logistic models for clustered data adjusting for the time between symptoms' onset and date of sampling.
RESULTS
From March to May 2020, 267 LRT samples were performed in 90 patients from both centers. The median time to negativity was 29 (IQR 23; 34) days. Prolonged viral shedding was not associated with age, gender, cardiac comorbidities, diabetes, immunosuppression, corticosteroids use, or antiviral therapy. The LRT viral load tended to be higher in non-survivors. This difference was statistically significant after adjusting for the time interval between onset of symptoms and date of sampling (OR 3.78, 95% CI 1.13-12.64, p = 0.03).
CONCLUSIONS
The viral shedding in LRT lasted almost 30 days in median in critically ill patients, and the viral load in the LRT was associated with the 6-week mortality.
Identifiants
pubmed: 33066801
doi: 10.1186/s13054-020-03323-5
pii: 10.1186/s13054-020-03323-5
pmc: PMC7562762
doi:
Banques de données
ClinicalTrials.gov
['NCT04262921']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
610Subventions
Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (CH)
ID : P400PM_183865
Pays : International
Organisme : Gottfried und Julia Bangerter-Rhyner-Stiftung
ID : NA
Pays : International
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