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Meta-Analysis
. 2020 Sep 29;24(1):584.
doi: 10.1186/s13054-020-03296-5.

Effect of antiviral therapy on the outcomes of mechanically ventilated patients with herpes simplex virus detected in the respiratory tract: a systematic review and meta-analysis

Stefan Hagel  1 , André Scherag  2   3 , Lukas Schuierer  4   5 , Reinhard Hoffmann  5 , Charles-Edouard Luyt  6 , Mathias W Pletz  7 , Miriam Kesselmeier  2   3 , Sebastian Weis  7   8   9
Affiliations
Meta-Analysis

Effect of antiviral therapy on the outcomes of mechanically ventilated patients with herpes simplex virus detected in the respiratory tract: a systematic review and meta-analysis

Stefan Hagel et al. Crit Care. .

Abstract

Background: Herpes simplex virus (HSV) is frequently detected in the respiratory tract of mechanically ventilated patients. The aim of this study was to assess current evidence to determine whether antiviral therapy is associated with better outcomes in these patients.

Methods: MEDLINE, ISI Web of Science, Cochrane Database and ClinicalTrials.gov were searched from inception to 25 May 2020. All clinical studies investigating the effects of antiviral therapy on the outcome of mechanically ventilated ICU patients in whom HSV was detected in the respiratory tract were eligible for inclusion, regardless of study design, publication status or language. Titles and abstracts were reviewed independently by two authors. If the articles seemed eligible, full-text articles were reviewed and data extracted. We performed a random-effects meta-analysis to estimate relative risks (RRs) with corresponding 95% confidence intervals (CIs). The primary endpoint was hospital all-cause mortality.

Results: Nine studies were included in the meta-analysis (one randomized controlled trial, eight cohort studies). Antiviral treatment was associated with lower hospital mortality (with antiviral treatment, 40.6% (189 out of 465 patients); without, 52.7% (193 out of 366 patients); RR 0.74 [0.64, 0.85]; eight studies, low quality of evidence). Furthermore, antiviral treatment was associated with lower 30-day mortality (RR 0.75 [0.59, 0.94]; three studies, very low quality of evidence). We did not observe evidence for differences in ICU mortality (RR 0.73 [0.51, 1.05]; three studies, very low quality of evidence).

Conclusions: This meta-analysis of the available data shows that antiviral therapy might result in lower hospital and 30-day all-cause mortality in mechanically ventilated ICU patients who are positive for HSV in the respiratory tract. However, this result must be interpreted with great caution due to the high risk of bias and limited number of patients. Large, well-designed randomized controlled clinical trials are urgently needed.

Trial registration: The study was registered in advance on International Prospective Register of Systematic Reviews (CRD42020180053) .

Keywords: Antiviral therapy; Critically ill; Herpes simplex; Mechanical ventilation.

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Conflict of interest statement

C.E.L. has received personal fees from Carmat, Merck, Biomérieux, Thermofischer Brahms, Bayer Healthcare and Faron, outside the submitted work. All other authors declare that they have no potential financial conflicts of interest regarding the contents of the publication.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study identification and selection process for outcome analysis
Fig. 2
Fig. 2
Results for the primary and secondary endpoints in mechanically ventilated patients with HSV detection in respiratory tract. CI, confidence interval; HSV, herpes simplex virus; ICU, intensive care unit; RR, relative risk
See this image and copyright information in PMC

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