Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO
Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO
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DOI：
10.1186/s13613-019-0616-6
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发表时间：
2019-12-23
影响因子：
8.1
通讯作者：
Papazian, Laurent
中科院分区：
文献类型：
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作者：
Hraiech, Sami;Bonnardel, Eline;Papazian, Laurent
背景：疱疹病毒在非免疫功能低下的危重患者中的再激活与预后受损有关，特别是在急性呼吸窘迫综合征（ARDS）期间。然而，在静脉-静脉体外膜氧合（ECMO）下，严重ARDS患者发生单纯疱疹病毒（HSV）和巨细胞病毒（CMV）再激活的情况尚不清楚。我们试图确定疱疹病毒再激活的频率及其对重症ARDS患者ECMO期间预后的影响。结果：在5年的时间里，123例非免疫功能低下的严重ARDS患者需要静脉-静脉ECMO。67例患者（54%）在ECMO过程中经历了HSV和/或CMV再激活（20例病毒合并感染，40例单纯HSV， 7例单纯CMV）。在MV开始后，HSV的再激活比CMV更早发生[(6-15)vs. 19（13-29）天；p < 0.01]和ECMO实施后[(2-8)vs. 14（10-20）天；P < 0.01]。在单因素分析中，HSV/CMV再激活与机械通气持续时间较长相关[(22-52.5)vs. 17.5（9-28）天；p < 0.01]， ECMO持续时间较长[15 (10-22.5)vs. 9（5-14）天；p < 0.01]， ICU时间延长[29（19.5 ~ 47.5）天和16（9 ~ 30）天；住院天数[44 (29-63.5)vs. 24 (11-43) d]；P < 0.01]。然而，在多变量分析中，病毒再激活仍然只与延长的MV有关。当单独考虑时，与未激活的患者相比，HSV和CMV再激活与MV持续时间更长相关[分别为29（19.5-41）和28 (20.5-37),vs. 17.5（9-28）天；P < 0.05]。共同再激活患者的MV持续时间更长[58.5 (38-72.3)；p < 0.05]和ICU住院时间[分别为51.5（32.5-69）比27.5（17.75-35.5）和29(20-30.5)]，与单纯HSV或CMV再激活患者相比。在多变量分析中，HSV再激活仍然与MV持续时间和住院时间独立相关。结论：疱疹病毒再激活在静脉-静脉ECMO下的严重ARDS患者中很常见，并与较长的机械通气时间有关。在ECMO下，HSV和CMV再激活与呼吸功能恶化之间的直接因果关系仍有待证实。
Background: Herpesviridae reactivation among non-immunocompromised critically ill patients is associated with impaired prognosis, especially during acute respiratory distress syndrome (ARDS). However, little is known about herpes simplex virus (HSV) and Cytomegalovirus (CMV) reactivation occurring in patients with severe ARDS under veno-venous extracorporeal membrane oxygenation (ECMO). We tried to determine the frequency of Herpesviridae reactivation and its impact on patients' prognosis during ECMO for severe ARDS.Results: During a 5-year period, 123 non-immunocompromised patients with a severe ARDS requiring a veno-venous ECMO were included. Sixty-seven patients (54%) experienced HSV and/or CMV reactivation during ECMO course (20 viral co-infection, 40 HSV alone, and 7 CMV alone). HSV reactivation occurred earlier than CMV after the beginning of MV [(6-15) vs. 19 (13-29) days; p < 0.01] and after ECMO implementation [(2-8) vs. 14 (10-20) days; p < 0.01]. In univariate analysis, HSV/CMV reactivation was associated with a longer duration of mechanical ventilation [(22-52.5) vs. 17.5 (9-28) days; p < 0.01], a longer duration of ECMO [15 (10-22.5) vs. 9 (5-14) days; p < 0.01], and a prolonged ICU [29 (19.5-47.5) vs. 16 (9-30) days; p < 0.01] and hospital stay [44 (29-63.5) vs. 24 (11-43) days; p < 0.01] as compared to non-reactivated patients. However, in multivariate analysis, viral reactivation remained associated with prolonged MV only. When considered separately, both HSV and CMV reactivation were associated with a longer duration of MV as compared to non-reactivation patients [29 (19.5-41) and 28 (20.5-37), respectively, vs. 17.5 (9-28) days; p < 0.05]. Co-reactivation patients had a longer duration of MV [58.5 (38-72.3); p < 0.05] and ICU stay [51.5 (32.5-69) vs. 27.5 (17.75-35.5) and 29 (20-30.5), respectively] as compared to patients with HSV or CMV reactivation alone. In multivariate analysis, HSV reactivation remained independently associated with a longer duration of MV and hospital length of stay.Conclusions: Herpesviridae reactivation is frequent among patients with severe ARDS under veno-venous ECMO and is associated with a longer duration of mechanical ventilation. The direct causative link between HSV and CMV reactivation and respiratory function worsening under ECMO remains to be confirmed.