Protracted viral shedding and viral load are associated with ICU mortality in Covid-19 patients with acute respiratory failure.
Protracted viral shedding and viral load are associated with ICU mortality in Covid-19 patients with acute respiratory failure.
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DOI：
10.1186/s13613-020-00783-4
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发表时间：
2020-12-10
影响因子：
8.1
通讯作者：
Richard JC
中科院分区：
文献类型：
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作者：
Bitker L;Dhelft F;Chauvelot L;Frobert E;Folliet L;Mezidi M;Trouillet-Assant S;Belot A;Lina B;Wallet F;Richard JC
在住院的COVID-19肺炎患者中，前病毒脱落很常见，出院后高达40%的患者在计算机断层扫描（CT）上显示肺纤维化体征。我们假设，在重症监护室（ICU）死亡的COVID-19急性呼吸衰竭（ARF）患者的呼吸道病毒清除率低于ICU存活出院患者，并且呼吸道样本中持续的病毒脱落与肺部CT上的纤维增生模式相关。因此，我们在里昂大学医院的2个ICU中进行了一项回顾性观察研究。129例患者入组研究，其中44例（34%）死于ICU。对432例SARS冠状病毒2型进行RT-PCR检测，对137例CT扫描结果进行分析。在调整病毒采样部位和RT-PCR技术后，死亡患者的病毒载量显著高于ICU出院时存活的患者（p < 0.001）。在ICU出院时存活的患者中，至RT-PCR检测SARS-CoV-2阴性的中位时间为19天[CI 95%：15-21]，在ICU出院时死亡的患者中为26天[CI 95%：17-无穷大]。竞争性风险回归分析发现，ICU死亡患者和年龄是延长RT-PCR检测SARS-CoV-2阴性时间的独立风险因素，而抗病毒治疗与缩短时间独立相关。没有一个CT评分探索纤维增生（即，支气管扩张和网状评分）与SARS-CoV-2阴性时间显著相关。在COVID-19相关急性呼吸衰竭的ICU幸存者中，呼吸道样本中的病毒载量显著较低，病毒脱落显著较短。前病毒脱落与肺CT上纤维化的发生无关。
Protracted viral shedding is common in hospitalized patients with COVID-19 pneumonia, and up to 40% display signs of pulmonary fibrosis on computed tomography (CT) after hospital discharge. We hypothesized that COVID-19 patients with acute respiratory failure (ARF) who die in intensive care units (ICU) have a lower viral clearance in the respiratory tract than ICU patients discharged alive, and that protracted viral shedding in respiratory samples is associated with patterns of fibroproliferation on lung CT. We, therefore, conducted a retrospective observational study, in 2 ICU of Lyon university hospital. 129 patients were included in the study, of whom 44 (34%) died in ICU. 432 RT-PCR for SARS-CoV-2 were performed and 137 CT scans were analyzed. Viral load was significantly higher in patients deceased as compared to patients alive at ICU discharge (p < 0.001), after adjustment for the site of viral sampling and RT-PCR technique. The median time to SARS-CoV-2 negativation on RT-PCR was 19 days [CI95 %:15–21] in patients alive at ICU discharge and 26 days [CI95 %:17-infinity] in non-survivors at ICU discharge. Competitive risk regression identified patients who died in ICU and age as independent risk factors for longer time to SARS-CoV-2 negativation on RT-PCR, while antiviral treatment was independently associated with shorter time. None of the CT scores exploring fibroproliferation (i.e., bronchiectasis and reticulation scores) were significantly associated with time to SARS-CoV-2 negativation. Viral load in respiratory samples is significantly lower and viral shedding significantly shorter in ICU survivors of COVID-19 associated acute respiratory failure. Protracted viral shedding is unrelated to occurrence of fibrosis on lung CT.