Multiplex Polymerase Chain Reaction Assay to Detect Nasopharyngeal Viruses in Immunocompromised Patients With Acute Respiratory Failure.

BACKGROUND

In immunocompromised patients with acute respiratory failure (ARF), the clinical significance of respiratory virus detection in the nasopharynx remains uncertain.

RESEARCH QUESTION

Is viral detection in nasopharyngeal swabs associated with causes and outcomes of ARF in immunocompromised patients?

STUDY DESIGN AND METHODS

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.

RESULTS

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.

INTERPRETATION

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.

Informations de copyright

Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: J. L. reports receiving personal fees from Qiagen and Abbott Rapid Diagnostics SAS. V. L. received support for article research from Assistance Publique - Hôpitaux de Paris and is treasurer of the GRRR-OH research group, which has received fees from Pfizer, Fisher-Paykel, Gilead, Astellas, Sanofi, and Alexion. F. B. reports personal fees from Merck Sharp and Dohme and BioMérieux outside the submitted work. A. D. reports grants from the French Ministry of Health; grants and personal fees from Philips, Fisher & Paykel, Respinor, and Lungpacer; personal fees from Baxter, Getinge, Gilead, and Lowenstein; and nonfinancial support from Fisher & Paykel outside the submitted work. E. A. has received fees for lectures from MSD, Pfizer, and Alexion; his institution and research group have received support from Baxter, Jazz Pharmaceuticals, Fisher & Paykel, Gilead, Alexion, and Ablynx; and he received support for article research from Assistance Publique - Hôpitaux de Paris. None declared (A. M., M. B., S. M.-D., L. F., S. J., K. K., A. K., L. A., N. B., A.-S. M., E. C., F. P., M. S., D. M.).