SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients.
SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients.
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DOI：
10.1186/s13054-020-03323-5
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发表时间：
2020-10-16
期刊：
影响因子：
--
通讯作者：
Timsit JF
中科院分区：
文献类型：
--
作者：
Buetti N;Wicky PH;Le Hingrat Q;Ruckly S;Mazzuchelli T;Loiodice A;Trimboli P;Forni Ogna V;de Montmollin E;Bernasconi E;Visseaux B;Timsit JF
有关下呼吸道（LRT）中SARS-CoV-2载量的数据很少。我们的目的是描述LRT中的病毒脱落和病毒载量，并确定它们与重症COVID-19患者死亡率的相关性。我们进行了一项两国研究，合并了从法国和瑞士的两个COVID-19参考中心前瞻性收集的数据。首先，我们描述了病毒脱落持续时间（即，至阴性的时间）。其次，我们分析了LRT样本中的病毒载量。第三，我们使用混合效应logistic模型评估了LRT中病毒存在与死亡率之间的关系，该模型用于调整症状发作与采样日期之间的时间的聚类数据。2020年3月至5月，两个中心共对90名患者进行了267份LRT样本。至阴性的中位时间为29（IQR 23; 34）天。病毒排出时间延长与年龄、性别、心脏合并症、糖尿病、免疫抑制、皮质类固醇使用或抗病毒治疗无关。LRT病毒载量在非幸存者中往往较高。在调整症状发作与采样日期之间的时间间隔后，该差异具有统计学显著性（OR 3.78，95% CI 1.13-12.64，p = 0.03）。重症患者中，LRT中的病毒脱落持续了近30天（中位数），LRT中的病毒载量与6周死亡率相关。
Data on SARS-CoV-2 load in lower respiratory tract (LRT) are scarce. Our objectives were to describe the viral shedding and the viral load in LRT and to determine their association with mortality in critically ill COVID-19 patients. We conducted a binational study merging prospectively collected data from two COVID-19 reference centers in France and Switzerland. First, we described the viral shedding duration (i.e., time to negativity) in LRT samples. Second, we analyzed viral load in LRT samples. Third, we assessed the association between viral presence in LRT and mortality using mixed-effect logistic models for clustered data adjusting for the time between symptoms’ onset and date of sampling. From March to May 2020, 267 LRT samples were performed in 90 patients from both centers. The median time to negativity was 29 (IQR 23; 34) days. Prolonged viral shedding was not associated with age, gender, cardiac comorbidities, diabetes, immunosuppression, corticosteroids use, or antiviral therapy. The LRT viral load tended to be higher in non-survivors. This difference was statistically significant after adjusting for the time interval between onset of symptoms and date of sampling (OR 3.78, 95% CI 1.13–12.64, p = 0.03). The viral shedding in LRT lasted almost 30 days in median in critically ill patients, and the viral load in the LRT was associated with the 6-week mortality.
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