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SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients.
Crit Care. 2020 10 16; 24(1):610.CC

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

University of Paris, INSERM, IAME, F-75006, Paris, France. niccolo.buetti@gmail.com. Ente Ospedaliero Cantonale, Locarno Community Hospital, Locarno, Switzerland. niccolo.buetti@gmail.com. Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. niccolo.buetti@gmail.com.Medical and Infectious Diseases ICU (MI2), Bichat-Claude Bernard Hospital, AP-HP, 75018, Paris, France.University of Paris, INSERM, IAME, F-75006, Paris, France. AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de virologie, F-75018, Paris, France.University of Paris, INSERM, IAME, F-75006, Paris, France.Ente Ospedaliero Cantonale, Locarno Community Hospital, Locarno, Switzerland.University of Paris, INSERM, IAME, F-75006, Paris, France.Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland. Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland.Ente Ospedaliero Cantonale, Locarno Community Hospital, Locarno, Switzerland.University of Paris, INSERM, IAME, F-75006, Paris, France. Medical and Infectious Diseases ICU (MI2), Bichat-Claude Bernard Hospital, AP-HP, 75018, Paris, France.Ente Ospedialiero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.University of Paris, INSERM, IAME, F-75006, Paris, France. AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de virologie, F-75018, Paris, France.University of Paris, INSERM, IAME, F-75006, Paris, France. Medical and Infectious Diseases ICU (MI2), Bichat-Claude Bernard Hospital, AP-HP, 75018, Paris, France.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33066801

Citation

Buetti, Niccolò, et al. "SARS-CoV-2 Detection in the Lower Respiratory Tract of Invasively Ventilated ARDS Patients." Critical Care (London, England), vol. 24, no. 1, 2020, p. 610.
Buetti N, Wicky PH, Le Hingrat Q, et al. SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients. Crit Care. 2020;24(1):610.
Buetti, N., Wicky, P. H., Le Hingrat, Q., Ruckly, S., Mazzuchelli, T., Loiodice, A., Trimboli, P., Forni Ogna, V., de Montmollin, E., Bernasconi, E., Visseaux, B., & Timsit, J. F. (2020). SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients. Critical Care (London, England), 24(1), 610. https://doi.org/10.1186/s13054-020-03323-5
Buetti N, et al. SARS-CoV-2 Detection in the Lower Respiratory Tract of Invasively Ventilated ARDS Patients. Crit Care. 2020 10 16;24(1):610. PubMed PMID: 33066801.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients. AU - Buetti,Niccolò, AU - Wicky,Paul-Henri, AU - Le Hingrat,Quentin, AU - Ruckly,Stéphane, AU - Mazzuchelli,Timothy, AU - Loiodice,Ambre, AU - Trimboli,Pierpaolo, AU - Forni Ogna,Valentina, AU - de Montmollin,Etienne, AU - Bernasconi,Enos, AU - Visseaux,Benoit, AU - Timsit,Jean-François, Y1 - 2020/10/16/ PY - 2020/08/19/received PY - 2020/10/04/accepted PY - 2020/10/17/entrez PY - 2020/10/18/pubmed PY - 2020/10/22/medline KW - COVID-19 KW - ICU KW - Lower respiratory tract KW - Mortality KW - SARS-CoV-2 KW - Viral load KW - Viral shedding SP - 610 EP - 610 JF - Critical care (London, England) JO - Crit Care VL - 24 IS - 1 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/33066801/SARS_CoV_2_detection_in_the_lower_respiratory_tract_of_invasively_ventilated_ARDS_patients_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03323-5 DB - PRIME DP - Unbound Medicine ER -