scholarly journals Protracted viral shedding and viral load are associated with ICU mortality in Covid-19 patients with acute respiratory failure

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
L. Bitker ◽  
F. Dhelft ◽  
L. Chauvelot ◽  
E. Frobert ◽  
L. Folliet ◽  
...  
Keyword(s):  
Viral Load ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Antiviral Treatment ◽  
University Hospital ◽  
Rt Pcr ◽  
Viral Shedding ◽  
Icu Discharge ◽  
Independent Risk Factors ◽  
Lung Ct

Abstract Background 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. Results 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. Conclusions 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.

scholarly journals Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study

2021 ◽  
Vol 18 (21) ◽  
pp. 11534
Author(s):  
Stefano Sartini ◽  
Laura Massobrio ◽  
Ombretta Cutuli ◽  
Paola Campodonico ◽  
Cristina Bernini ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Adverse Outcome ◽  
University Hospital ◽  
Rt Pcr ◽  
Threatening Condition ◽  
Life Threatening ◽  
Group A ◽  
Group B ◽  
The University

COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 <60 and >100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.

scholarly journals ANTIVIRAL TREATMENT OPTIONS FOR COVID-19 BY REDUCTION OF VIRAL LOAD AND VIRAL SHEDDING

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Chandrika Murugaiah
Keyword(s):  
Viral Load ◽  
Antiviral Treatment ◽  
Treatment Options ◽  
Cardiac Injury ◽  
Respiratory Illness ◽  
Viral Shedding ◽  
Viral Particles ◽  
Wide Range ◽  
Highly Correlated ◽  
Viral Development

The coronavirus disease 2019 (COVID-19) virus is a public health emergency of international concern, without known effective pharmaceutical treatment so far. It is difficult to treat infected patients who are experiencing acute respiratory failure, liver or cardiac injury, gastroenteritis and many other complications without any drug recommendation. Reducing the viral load is the most important key for Covid-19 treatment, where complication due to infection is highly correlated with the number of viral particles present in the lung and other organs of the patient. Most antivirals are effective against a wide range of viruses, where they inhibit viral development. Some of the possible antiviral treatment options for COVID-19 could be discovered from flu viral treatment that had led to quick respiratory illness recovery through reduction of viral load and viral shedding.

scholarly journals Effect of Lopinavir/Ritonavir Treatment On COVID-2019 Transmissibility: A Possible Option To Reduce Isolation Time

2021 ◽  
Author(s):  
Dong-Min Kim ◽  
Jae Keun Chung ◽  
Choon-Mee Kim ◽  
Mi-Seon Bang ◽  
Misbah Tariq ◽  
...  
Keyword(s):  
Viral Load ◽  
Lower Respiratory Tract ◽  
Antiviral Agent ◽  
Healthcare Systems ◽  
Rt Pcr ◽  
Load Duration ◽  
Viral Shedding ◽  
Number Of Patients ◽  
The Mean ◽  
Hospital Wards

Abstract Owing to the coronavirus disease 2019 (COVID-19) pandemic, there is a shortage of hospital wards to accommodate the increasing number of patients, especially in intensive care units. Healthcare systems are collapsing in many countries. Therefore, it is necessary to reduce isolation time. We examined the effect of lopinavir/ritonavir administration in patients with SARS-CoV-2. To assess the viral load, duration and clearance of viable virus; cell culture and RT-PCR were performed in parallel. No viable SARS-CoV-2 could be detected after administration of lopinavir/ritonavir with median time of viable viral clearance being one day after administration. The mean viral load in both upper and lower respiratory tract samples of lopinavir/ritonavir administered group was significantly lower than the group who were not treated with any antiviral agent. The duration of viable viral shedding was shorter in patients with lopinavir/ritonavir treatment compared with those without treatment. This study suggests that lopinavir/ritonavir treatment offers a possible method to reduce isolation time of patients infected with the SARS-CoV-2.

scholarly journals Prognostic value of lymphocyte counts in bronchoalveolar lavage fluid in patients with acute respiratory failure: a retrospective cohort study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Yasutaka Hirasawa ◽  
Taka-aki Nakada ◽  
Takashi Shimazui ◽  
Mitsuhiro Abe ◽  
Yuri Isaka ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Bronchoalveolar Lavage ◽  
Bronchoalveolar Lavage Fluid ◽  
Ventilatory Support ◽  
Lavage Fluid ◽  
University Hospital ◽  
Secondary Outcome ◽  
Youden Index ◽  
Outcome Analysis

Abstract Background Cellular patterns in bronchoalveolar lavage fluid (BALF) are used to distinguish or rule out particular diseases in patients with acute respiratory failure (ARF). However, whether BALF cellular patterns can predict mortality or not is unknown. We test the hypothesis that BALF cellular patterns have predictive value for mortality in patients with ARF. Methods This was a retrospective single-center observational study conducted in a Japanese University Hospital. Consecutive patients (n = 78) with both pulmonary infiltrates and ARF who were examined by bronchoalveolar lavage (BAL) between April 2015 and May 2018 with at least 1 year of follow-up were analyzed. Primary analysis was receiver operating characteristic curve—area under the curve (ROC-AUC) analysis for 1-year mortality. Results Among the final sample size of 78 patients, survivors (n = 56) had significantly increased lymphocyte and eosinophil counts and decreased neutrophil counts in BALF compared with non-survivors (n = 22). Among the fractions, lymphocyte count was the most significantly different (30 [12-50] vs. 7.0 [2.9-13]%, P <0.0001). In the ROC curve analysis of the association of BALF lymphocytes with 1-year mortality, the AUC was 0.787 (P <0.0001, cut-off value [Youden index] 19.0%). Furthermore, ≥20% BALF lymphocytes were significantly associated with increased survival with adjustment for baseline imbalances (1-year adjusted hazard ratio, 0.0929; 95% confidence interval, 0.0147–0.323, P <0.0001; 90-day P =0.0012). Increased survival was significantly associated with ≥20% BALF lymphocytes in both interstitial lung disease (ILD) and non-ILD subgroups (P =0.0052 and P =0.0033, respectively). In secondary outcome analysis, patients with ≥20% BALF lymphocytes had significantly increased ventilator-free days, which represents less respiratory dysfunction than those with <20% BALF lymphocytes. Conclusions In the patients with ARF, ≥20% lymphocytes in BALF was associated with significantly less ventilatory support, lower mortality at both 90-day and 1-year follow-ups.

scholarly journals Factors associated with prolonged viral shedding and impact of lopinavir/ritonavir treatment in hospitalised non-critically ill patients with SARS-CoV-2 infection

2020 ◽  
Vol 56 (1) ◽  
pp. 2000799 ◽  
Author(s):  
Dan Yan ◽  
Xiao-Yan Liu ◽  
Ya-nan Zhu ◽  
Li Huang ◽  
Bi-tang Dan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Symptom Onset ◽  
Antiviral Treatment ◽  
Older Age ◽  
Rna Detection ◽  
Factors Associated ◽  
Viral Shedding ◽  
Reverse Transcription Pcr ◽  
Independent Risk Factors ◽  
The Impact

BackgroundThe duration of viral shedding is central to the guidance of decisions about isolation precautions and antiviral treatment. However, studies regarding the risk factors associated with prolonged shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the impact of lopinavir/ritonavir (LPV/r) treatment on viral shedding remain scarce.MethodsData were collected from all SARS-CoV-2 infected patients who were admitted to isolation wards and had reverse transcription PCR conversion at the No. 3 People's Hospital of Hubei province, China, between 31 January and 9 March 2020. We compared clinical characteristics and SARS-CoV-2 RNA shedding between patients initiated with LPV/r treatment and those without. Logistic regression analysis was employed to evaluate the risk factors associated with prolonged viral shedding.ResultsOf 120 patients, the median age was 52 years, 54 (45%) were male and 78 (65%) received LPV/r treatment. The median duration of SARS-CoV-2 RNA detection from symptom onset was 23 days (interquartile range 18–32 days). Older age (OR 1.03, 95% CI 1.00–1.05; p=0.03) and the lack of LPV/r treatment (OR 2.42, 95% CI 1.10–5.36; p=0.029) were independent risk factors for prolonged SARS-CoV-2 RNA shedding. Patients who initiated LPV/r treatment within 10 days from symptom onset, but not initiated from day 11 onwards, had significantly shorter viral shedding duration compared with those without LPV/r treatment (median 19 days versus 28.5 days; log-rank p<0.001).ConclusionOlder age and the lack of LPV/r treatment were independently associated with prolonged SARS-CoV-2 RNA shedding in patients with coronavirus disease 2019 (COVID-19). Earlier administration of LPV/r treatment could shorten viral shedding duration.

Predictive Factors of Acute Respiratory Failure in Esophagectomy for Esophageal Malignancy

2012 ◽  
Vol 78 (10) ◽  
pp. 1024-1028 ◽  
Author(s):  
Hossein Masoomi ◽  
Brian Nguyen ◽  
Brian R. Smith ◽  
Michael J. Stamos ◽  
Ninh T. Nguyen
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Patient Characteristics ◽  
Surgical Decision ◽  
Preoperative Risk Factors ◽  
Nationwide Inpatient Sample Database ◽  
Total Esophagectomy ◽  
Potential Risks ◽  
Independent Risk Factors

Acute respiratory failure (ARespF) is a common complication after esophagectomy that contributes to higher morbidity and mortality. Using the Nationwide Inpatient Sample database, we sought to identify predictors of ARespF in 6352 patients who underwent esophagectomy for malignancy between 2006 and 2008. Multivariate regression analyses were performed to identify preoperative factors (patient characteristics, comorbidities, procedural type, tumor's location, hospital teaching status, and payer type) predictive of ARespF in esophagectomy. The overall rate of ARespF was 27.08 per cent. For comorbidities, independent risk factors for higher rate of ARF included weight loss (adjusted odds ratio [AOR], 3.63; 95% confidence interval [CI], 3.02 to 4.37), pulmonary hypertension (AOR, 2.38; 95% CI, 1.85 to 3.45), congestive heart failure (AOR, 2.35; 95% CI, 1.77 to 3.13), liver disease (AOR, 1.95; 95% CI, 1.22 to 3.12), chronic lung disease (AOR, 1.40; 95% CI, 1.17 to 1.66), and anemia (AOR, 1.26; 95% CI, 1.04 to 1.51). Cervical location of malignancy (AOR, 2.32; 95% CI, 1.51 to 3.56), total esophagectomy (AOR, 1.64; 95% CI, 1.41 to 1.90), and non-teaching hospital (AOR, 1.45; 95% CI, 1.20 to 1.75) were independent risk factors for ARespF. There was no effect of age, gender, race, hypertension, diabetes, renal failure, obesity, smoking, peripheral vascular disorder, or payer type on ARespF. We identified multiple preoperative risk factors that have an impact on development of ARespF after esophagectomy. Surgeons can use these factors to inform patients of potential risks and should consider these factors during surgical-decision making.

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