The following is a summary of “Prognosis of critically ill immunocompromised patients with virus-detected acute respiratory failure,” published in the October 2023 issue of Critical Care by Dumas et al.
Researchers started a retrospective study to describe the spectrum of critically ill immunocompromised patients with virus-detected acute respiratory failure (ARF) and to report their outcomes.
They utilized the Groupe de Recherche en Réanimation respiratoire en Onco-Hématologie’s database (2003–2017, 72 intensive care units) to outline the range of critically ill immunocompromised patients with virus-detected ARF and reported their outcomes. Next, virus-detected ARF patients were matched 1:3 with ARF patients from different origins based on clinical characteristics and severity.
The results showed 4038 immunocompromised patients and 370 (9.2%) were diagnosed with virus-detected ARF. Influenza was the predominant virus (59%), followed by respiratory syncytial virus (14%), displaying significant seasonal variation. Among them, 79 patients (21%) had an associated bacterial infection, and 23 (6%) had invasive pulmonary aspergillosis. The crude in-hospital mortality rate was 37.8%. Factors linked to mortality included neutropenia (OR = 1.74, 95% CI [1.05–2.89]), poor performance status (OR = 1.84, CI [1.12–3.03]), and the requirement for invasive mechanical ventilation on the day of admission (OR = 1.97, CI [1.14–3.40]). Virus type did not show an association with mortality. Post-matching, patients with virus-detected ARF exhibited lower mortality (OR = 0.77, CI [0.60–0.98]) than those with ARF from other causes. Influenza-like viruses, including respiratory syncytial, parainfluenza, and human metapneumovirus, primarily influenced this difference(OR = 0.54, CI [0.33–0.88]).
They concluded that immunocompromised patients with virus-detected ARF have high mortality but lower than non-viral ARF, especially for viruses other than influenza.