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. 2020 Oct 16;24(1):610.
doi: 10.1186/s13054-020-03323-5.

SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients

Niccolò Buetti  1   2   3 , Paul-Henri Wicky  4 , Quentin Le Hingrat  5   6 , Stéphane Ruckly  5 , Timothy Mazzuchelli  7 , Ambre Loiodice  5 , Pierpaolo Trimboli  8   9 , Valentina Forni Ogna  7 , Etienne de Montmollin  5   4 , Enos Bernasconi  10 , Benoit Visseaux  5   6 , Jean-François Timsit  5   4
Affiliations

SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients

Niccolò Buetti et al. Crit Care. .

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.

Trial registration: ClinicalTrials.gov NCT04262921.

Keywords: COVID-19; ICU; Lower respiratory tract; Mortality; SARS-CoV-2; Viral load; Viral shedding.

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Conflict of interest statement

The authors have disclosed that they do not have conflict of interest. JFT received fees for lectures to 3M, MSD, Pfizer, and Biomerieux. JFT received research grants from Astellas, 3M, MSD, and Pfizer. JFT participated to advisory boards of 3M, MSD, Bayer Pharma, Nabriva, and Pfizer. BV reports grants, personal fees for lectures, and travel accommodations from Qiagen. BV received personal fees for lecture and travel accommodation support from BioMérieux. BV received personal fees for lectures from Hologic and Gilead.

Figures

Fig. 1
Fig. 1
Viral shedding in lower respiratory tract for the different patient populations, according to patients’ characteristics and to treatments received. For this descriptive analysis, we performed a log rank test for the different subgroups
Fig. 2
Fig. 2
Viral load among survivors and non-survivors at 6 weeks, stratified by the time between symptoms’ onset and date of sampling. For this descriptive analysis, we performed a Wilcoxon test between survivors and non-survivors. N, number of lower respiratory tract samples performed
See this image and copyright information in PMC

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