Prognosis of critically ill immunocompromised patients with virus-detected acute respiratory failure

Guillaume Dumas; Maxime Bertrand; Virginie Lemiale; Emmanuel Canet; François Barbier; Achille Kouatchet; Alexandre Demoule; Kada Klouche; Anne-Sophie Moreau; Laurent Argaud; Florent Wallet; Jean-Herlé Raphalen; Djamel Mokart; Fabrice Bruneel; Frédéric Pène; Elie Azoulay

doi:10.1186/s13613-023-01196-9

Prognosis of critically ill immunocompromised patients with virus-detected acute respiratory failure

Ann Intensive Care. 2023 Oct 13;13(1):101. doi: 10.1186/s13613-023-01196-9.

Authors

Guillaume Dumas¹, Maxime Bertrand^{2

3}, Virginie Lemiale^{2

3}, Emmanuel Canet⁴, François Barbier⁵, Achille Kouatchet⁶, Alexandre Demoule⁷, Kada Klouche⁸, Anne-Sophie Moreau⁹, Laurent Argaud¹⁰, Florent Wallet¹¹, Jean-Herlé Raphalen¹², Djamel Mokart¹³, Fabrice Bruneel¹⁴, Frédéric Pène^{15

16}, Elie Azoulay^{2

3}

Affiliations

¹ Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes; Université Grenoble-Alpes, INSERM U1300-HP2, Grenoble, France. dumas.guillaume1@gmail.com.
² Medical Intensive Care Unit, Saint-Louis Teaching Hospital, AP-HP, Paris, France.
³ ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université de Paris, Paris, France.
⁴ Nantes Université, CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France.
⁵ Medical Intensive Care Unit, La Source Hospital, CHR Orleans, Orleans, France.
⁶ Medical Intensive Care Unit, Angers Teaching Hospital, Angers, France.
⁷ Service de Médecine Intensive et Réanimation (Département R3S), Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, and AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France.
⁸ Medical Intensive Care Unit, CHU de Montpellier, Montpellier, France.
⁹ Service de Réanimation Polyvalente, CHRU de Lille - Hôpital Roger Salengro, Lille, France.
¹⁰ Medical Intensive Care Unit, Hospices Civils de Lyon, Hopital Edouard Herriot, Lyon, France.
¹¹ Intensive Care Unit, Lyon Sud Medical Center, Lyon, France.
¹² Department of Anesthesia and Critical Care, Necker Hospital, Paris, France.
¹³ Intensive Care Unit, Institut Paoli Calmettes, Marseille, France.
¹⁴ Medical Intensive Care Unit, Andre Mignot Hospital, Versailles, France.
¹⁵ Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France.
¹⁶ Institut Cochin, INSERM Unité 1016/Centre National de La Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 8104/Université de Paris, Paris, France.

Abstract

Background: 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.

Results: 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]).

Conclusions: 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.

Keywords: Immunocompromised; Influenza; Mechanical ventilation; Pneumonia; Respiratory virus.