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Abstract
Rationale: Noninvasive diagnostic multiplex molecular tests may enable the early identification and treatment of viral infections in critically ill immunocompromised patients. Objectives: To assess the association between viral detection in nasopharyngeal swabs and ICU mortality in critically ill hematology patients. Methods: This 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 Results: Of 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). Conclusions: Respiratory 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.
Keywords
Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine, hematology, influenza, respiratory virus, mechanical ventilation, multiplex PCR, ACUTE RESPIRATORY-FAILURE, STEM-CELL TRANSPLANTATION, POLYMERASE-CHAIN-REACTION, HUMAN RHINOVIRUS, IMMUNOCOMPROMISED PATIENTS, OSELTAMIVIR TREATMENT, DIAGNOSTIC STRATEGY, ONCOLOGY PATIENTS, ADULT RECIPIENTS, INFLUENZA-VIRUS

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MLA
Legoff, Jérôme et al. “Clinical Significance of Upper Airway Virus Detection in Critically Ill Hematology Patients.” AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE 199.4 (2019): 518–528. Print.
APA
Legoff, J., Zucman, N., Lemiale, V., Mokart, D., Pène, F., Lambert, J., Kouatchet, A., et al. (2019). Clinical significance of upper airway virus detection in critically ill hematology patients. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 199(4), 518–528.
Chicago author-date
Legoff, Jérôme, Noémie Zucman, Virginie Lemiale, Djamel Mokart, Frédéric Pène, Jérôme Lambert, Achille Kouatchet, et al. 2019. “Clinical Significance of Upper Airway Virus Detection in Critically Ill Hematology Patients.” American Journal of Respiratory and Critical Care Medicine 199 (4): 518–528.
Chicago author-date (all authors)
Legoff, Jérôme, 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. 2019. “Clinical Significance of Upper Airway Virus Detection in Critically Ill Hematology Patients.” American Journal of Respiratory and Critical Care Medicine 199 (4): 518–528.
Vancouver
1.
Legoff J, Zucman N, Lemiale V, Mokart D, Pène F, Lambert J, et al. Clinical significance of upper airway virus detection in critically ill hematology patients. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. 2019;199(4):518–28.
IEEE
[1]
J. Legoff et al., “Clinical significance of upper airway virus detection in critically ill hematology patients,” AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, vol. 199, no. 4, pp. 518–528, 2019.
@article{8585829,
  abstract     = {Rationale: Noninvasive diagnostic multiplex molecular tests may enable the early identification and treatment of viral infections in critically ill immunocompromised patients.
Objectives: To assess the association between viral detection in nasopharyngeal swabs and ICU mortality in critically ill hematology patients.
Methods: This 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 Results: Of 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).
Conclusions: Respiratory 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.},
  author       = {Legoff, Jérôme and Zucman, Noémie and Lemiale, Virginie and Mokart, Djamel and Pène, Frédéric and Lambert, Jérôme and Kouatchet, Achille and Demoule, Alexandre and Vincent, François and Nyunga, Martine and Bruneel, Fabrice and Contejean, Adrien and Mercier-Delarue, Séverine and Rabbat, Antoine and Lebert, Christine and Perez, Pierre and Meert, Anne-Pascale and Benoit, Dominique and Schwebel, Carole and Jourdain, Mercé and Darmon, Michael and Resche-Rigon, Matthieu and Azoulay, Elie},
  issn         = {1073-449X},
  journal      = {AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE},
  keywords     = {Critical Care and Intensive Care Medicine,Pulmonary and Respiratory Medicine,hematology,influenza,respiratory virus,mechanical ventilation,multiplex PCR,ACUTE RESPIRATORY-FAILURE,STEM-CELL TRANSPLANTATION,POLYMERASE-CHAIN-REACTION,HUMAN RHINOVIRUS,IMMUNOCOMPROMISED PATIENTS,OSELTAMIVIR TREATMENT,DIAGNOSTIC STRATEGY,ONCOLOGY PATIENTS,ADULT RECIPIENTS,INFLUENZA-VIRUS},
  language     = {eng},
  number       = {4},
  pages        = {518--528},
  title        = {Clinical significance of upper airway virus detection in critically ill hematology patients},
  url          = {http://dx.doi.org/10.1164/rccm.201804-0681oc},
  volume       = {199},
  year         = {2019},
}

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