RATIONALE Noninvasive diagnostic multiplex molecular tests may enable the early identification and treatment of viral infections in critically ill immunocompromised patients. OBJECTIVES To assess the association between viral detection in nasopharyngeal swabs and ICU mortality in critically ill hematology patients. METHODS This was a post hoc analysis of a prospective cohort of critically ill hematology patients admitted to 17 ICUs. Nasal swabs sampled and frozen at ICU admission were tested using a multiplex PCR assay. Predictors of ICU mortality and assay positivity were identified. MEASUREMENTS AND MAIN RESULTS Of the 747 patients (447 with acute respiratory failure [ARF]), 21.3% had a virus detected (56.4% rhinovirus/enterovirus and 30.7% influenza/parainfluenza/respiratory syncytial viruses). Overall ICU and hospital mortality rates were 26% and 37%, respectively. Assay positivity was associated with lymphoproliferative disorders, hematopoietic stem cell transplantation, treatment with steroids or other immunosuppressants, ARF (25.5% vs. 16.3%; P = 0.004), and death in the ICU (28.9% vs. 19.3%; P = 0.008). The association with ICU mortality was significant for all viruses and was strongest for influenza/parainfluenza/respiratory syncytial viruses. In patients with ARF, detection of any respiratory virus was independently associated with ICU mortality (odds ratio, 2.07; 95% confidence interval, 1.22-3.50). CONCLUSIONS Respiratory virus detection in the upper airway by multiplex PCR assay is common in critically ill hematology patients. In patients with ARF, respiratory virus detection was independently associated with ICU mortality. Multiplex PCR assay may prove helpful for the risk stratification of hematology patients with ARF. Studies to understand whether respiratory tract viruses play a causal role in outcomes are warranted.

中文翻译：

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重症血液病患者上呼吸道病毒检测的临床意义。

理由：无创诊断性多重分子检测可以使重症免疫功能低下的患者早期识别和治疗病毒感染。目的评估危重血液病患者鼻咽拭子中病毒检测与ICU死亡率之间的关系。方法这是对入院17例重症监护病房的危重血液学患者的预期队列的事后分析。使用多重PCR分析法检测在ICU入院时取样并冷冻的鼻拭子。确定了ICU死亡率和测定阳性率的预测因子。测量和主要结果在747例患者（447例急性呼吸衰竭[ARF]）中，检测到21.3％的病毒（56.4％鼻病毒/肠病毒和30.7％流感/副流感/呼吸道合胞病毒）。ICU和医院的整体死亡率分别为26％和37％。检测阳性与淋巴增生性疾病，造血干细胞移植，类固醇或其他免疫抑制剂治疗，ARF（25.5％vs. 16.3％; P = 0.004）和ICU死亡（28.9％vs. 19.3％; P = 0.008）相关）。与ICU死亡率的关联对所有病毒均显着，对于流感/副流感/呼吸道合胞病毒最强。在患有ARF的患者中，任何呼吸道病毒的检测均独立于ICU死亡率（赔率，2.07； 95％置信区间，1.22-3.50）。结论多重PCR检测在上呼吸道中检测呼吸道病毒在重症血液病患者中很常见。在患有ARF的患者中，呼吸道病毒检测与ICU死亡率独立相关。多重PCR分析可能被证明有助于血液病ARF患者的危险分层。有必要进行研究以了解呼吸道病毒是否在结果中起因果作用。