Clinical Significance of Upper Airway Virus Detection in Critically Ill Hematology Patients

Jérôme Legoff 1, Noémie Zucman 2, Virginie Lemiale 2, Djamel Mokart 3, Frédéric Pène 4, Jérôme Lambert 5, Achille Kouatchet 6, Alexandre Demoule 7, François Vincent 8, Martine Nyunga 9, Fabrice Bruneel 10, Adrien Contejean 2, Séverine Mercier-Delarue 1, Antoine Rabbat 4, Christine Lebert 11, Pierre Perez 12, Anne-Pascale Meert 13, Dominique Benoit 14, Carole Schwebel 15, Mercé Jourdain 16, Michael Darmon 2, Matthieu Resche-Rigon 5, and Elie Azoulay 2

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.

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.