Tuberc Respir Dis.  2019 Oct;82(4):328-334. 10.4046/trd.2019.0017.

Characteristics and Outcomes of Patients with Pulmonary Acute Respiratory Distress Syndrome Infected with Influenza versus Other Respiratory Viruses

• Yoo JW
• Ju S
• Lee SJ
• Cho MC
• Cho YJ
• Jeong YY
• Lee JD
• Kim HC

• KMID: 2459057
• DOI: http://doi.org/10.4046/trd.2019.0017

Abstract

BACKGROUND
Although the frequency of respiratory viral infection in patients with pulmonary acute respiratory distress syndrome (ARDS) is not uncommon, clinical significance of the condition remains to be further elucidated. The purpose of this study was to compare characteristics and outcomes of patients with pulmonary ARDS infected with influenza and other respiratory viruses.
METHODS
Clinical data of patients with pulmonary ARDS infected with respiratory viruses January 2014-June 2018 were reviewed. Respiratory viral infection was identified by multiplex reverse transcription-polymerase chain reaction (RT-PCR).
RESULTS
Among 126 patients who underwent multiplex RT-PCR, respiratory viral infection was identified in 46% (58/126): 28 patients with influenza and 30 patients with other respiratory viruses. There was no significant difference in baseline and clinical characteristics between patients with influenza and those with other respiratory viruses. The use of extracorporeal membrane oxygenation (ECMO) was more frequent in patients with influenza than in those with other respiratory viruses (32.1% vs 3.3%, p=0.006). Co-bacterial pathogens were more frequently isolated from respiratory samples of patients with pulmonary ARDS infected with influenza virus than those with other respiratory viruses. (53.6% vs 26.7%, p=0.036). There were no significant differences regarding clinical outcomes. In multivariate analysis, acute physiology and chronic health evaluation II was associated with 30-mortality (odds ratio, 1.158; 95% confidence interval, 1.022-1.312; p=0.022).
CONCLUSION
Respiratory viral infection was not uncommon in patients with pulmonary ARDS. Influenza virus was most commonly identified and was associated with more co-bacterial infection and ECMO therapy.

Keyword

Acute Respiratory Distress Syndrome; Respiratory Virus; Multiplex Reverse Transcription Polymerase Chain Reaction; Outcomes

MeSH Terms

APACHE
Extracorporeal Membrane Oxygenation
Humans
Influenza, Human*
Multivariate Analysis
Orthomyxoviridae
Respiratory Distress Syndrome, Adult*

Figure

• 

  Figure 1 The number of patients with acute respiratory distress syndrome during the period. ARDS: acute respiratory distress syndrome; RT-PCR: reverse transcription–polymerase chain reaction.

Reference

1. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016; 315:788–800.

2. Nguyen C, Kaku S, Tutera D, Kuschner WG, Barr J. Viral respiratory infections of adults in the intensive care unit. J Intensive Care Med. 2016; 31:427–441.

3. Choi SH, Hong SB, Ko GB, Lee Y, Park HJ, Park SY, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012; 186:325–332.

4. Karhu J, Ala-Kokko TI, Vuorinen T, Ohtonen P, Syrjala H. Lower respiratory tract virus findings in mechanically ventilated patients with severe community-acquired pneumonia. Clin Infect Dis. 2014; 59:62–70.

5. Kim HJ, Choi SM, Lee J, Park YS, Lee CH, Yim JJ, et al. Respiratory virus of severe pneumonia in South Korea: prevalence and clinical implications. PLoS One. 2018; 13:e0198902.

6. Sanghavi SK, Bullotta A, Husain S, Rinaldo CR. Clinical evaluation of multiplex real-time PCR panels for rapid detection of respiratory viral infections. J Med Virol. 2012; 84:162–169.

7. Lee KY. Pneumonia, acute respiratory distress syndrome, and early immune-modulator therapy. Int J Mol Sci. 2017; 18:E388.

8. Shah RD, Wunderink RG. Viral pneumonia and acute respiratory distress syndrome. Clin Chest Med. 2017; 38:113–125.

9. Hong HL, Hong SB, Ko GB, Huh JW, Sung H, Do KH, et al. Viral infection is not uncommon in adult patients with severe hospital-acquired pneumonia. PLoS One. 2014; 9:e95865.

10. Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA. 2009; 302:1872–1879.

11. Jain S, Benoit SR, Skarbinski J, Bramley AM, Finelli L. 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team. Influenza-associated pneumonia among hospitalized patients with 2009 pandemic influenza A (H1N1) virus: United States, 2009. Clin Infect Dis. 2012; 54:1221–1229.

12. ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307:2526–2533.

13. Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India. Chest. 2006; 130:724–729.

14. Buchner J, Mazzeffi M, Kon Z, Menaker J, Rubinson L, Bittle G, et al. Single-center experience with venovenous ECMO for influenza-related ARDS. J Cardiothorac Vasc Anesth. 2018; 32:1154–1159.

15. Hasvold J, Sjoding M, Pohl K, Cooke C, Hyzy RC. The role of human metapneumovirus in the critically ill adult patient. J Crit Care. 2016; 31:233–237.

16. Cha MJ, Chung MJ, Lee KS, Kim TJ, Kim TS, Chong S, et al. Clinical features and radiological findings of adenovirus pneumonia associated with progression to acute respiratory distress syndrome: a single center study in 19 adult patients. Korean J Radiol. 2016; 17:940–949.

17. Choi SH, Huh JW, Hong SB, Lee JY, Kim SH, Sung H, et al. Clinical characteristics and outcomes of severe rhinovirus-associated pneumonia identified by bronchoscopic bronchoalveolar lavage in adults: comparison with severe influenza virus-associated pneumonia. J Clin Virol. 2015; 62:41–47.

18. Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005; 352:1749–1759.

19. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. Davies A, Jones D, Bailey M, Beca J, Bellomo R, et al. Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA. 2009; 302:1888–1895.

20. Pham T, Combes A, Roze H, Chevret S, Mercat A, Roch A, et al. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013; 187:276–285.

21. Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med. 2014; 189:1374–1382.

22. Martin-Loeches I, Schultz MJ, Vincent JL, Alvarez-Lerma F, Bos LD, Sole-Violan J, et al. Increased incidence of co-infection in critically ill patients with influenza. Intensive Care Med. 2017; 43:48–58.

23. Rozencwajg S, Brechot N, Schmidt M, Hekimian G, Lebreton G, Besset S, et al. Co-infection with influenza-associated acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Int J Antimicrob Agents. 2018; 51:427–433.