Spectrum of respiratory viral infectionsin liver disease patients with cirrhosis admitted in critical care unit

Vijeta Bajpai; Ekta Gupta; Lalita Gauri Mitra; Hemant Kumar; Rakhi Maiwall; Kapil Dev Soni; Amit Gupta

doi:10.4103/JLP.JLP_6_19

Journal of Laboratory Physicians, Table of Contents

CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(04): 356-360
DOI: 10.4103/JLP.JLP_6_19

Original Article

Spectrum of respiratory viral infectionsin liver disease patients with cirrhosis admitted in critical care unit

Authors

Vijeta Bajpai

Departments of Clinical Virology, JPNATC, All India Institute of Medical Sciences, New Delhi, India
Ekta Gupta

Departments of Clinical Virology, JPNATC, All India Institute of Medical Sciences, New Delhi, India
Lalita Gauri Mitra

Critical Care and Anaesthesia, JPNATC, All India Institute of Medical Sciences, New Delhi, India
Hemant Kumar

Pulmonary Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
Rakhi Maiwall

Hepatology, Institute of Liver and Biliary Sciences, JPNATC, All India Institute of Medical Sciences, New Delhi, India
Kapil Dev Soni

Department of Trauma and Critical Intensive Care Unit, JPNATC, All India Institute of Medical Sciences, New Delhi, India
Amit Gupta

Department of Surgery, JPNATC, All India Institute of Medical Sciences, New Delhi, India

Abstract

PDF Download

Abstract

BACKGROUND: Clinical significance of respiratory viruses (RVs) as an etiology of pneumonia in liver disease patients with cirrhosis is usually underestimated. Therefore, the aim of this study was to evaluate the spectrum of RVs in cirrhotic patients with pneumonia admitted in critical care units (CCUs) and its impact on the clinical outcome of cirrhotic patients.

MATERIAL AND METHOD: A prospective study was conducted in a tertiary care CCU, and consecutive cirrhotic patients with pneumonia were included. Bronchoalveolar lavage or throat swab/nasal swab was collected in viral transport medium for analysis of RVs by multiplex real-time polymerase chain reaction. A total of 135 cirrhotic patients were included, viral and bacterial etiology of pneumonia was identified, and analysis was done with the clinical outcome.

RESULTS: Overall, RVs were detected in 30 (22.2%) cirrhotic patients and viral–bacterial coinfection in 16 (11.8%) cirrhotic patients. The most common virus detected was rhinovirus in 9 (30%) patients. Mortality in cirrhotic patients with RV infection was significantly higher in comparison to cirrhotic patients with no RV infection (25 [83.3%] and 11 [12.3%], respectively, P < 0.001).

CONCLUSION: Respiratory viruses in cirrhotic patients with pneumonia are associated with poor clinical outcome.

Key words

Care - chronic liver disease - critical - pneumonia - respiratory virus - unit - viral–bacterial coinfection

PDF (662 kb)

References

References
1 Xu L, Ying S, Hu J, Wang Y, Yang M, Ge T, et al. Pneumonia in patients with cirrhosis: Risk factors associated with mortality and predictive value of prognostic models. Respir Res 2018;19:242.
2 Viasus D, Garcia-Vidal C, Castellote J, Adamuz J, Verdaguer R, Dorca J, et al. Community-acquired pneumonia in patients with liver cirrhosis: Clinical features, outcomes, and usefulness of severity scores. Medicine (Baltimore) 2011;90:110-8.
3 Hung TH, Tseng CW, Hsieh YH, Tseng KC, Tsai CC, Tsai CC. High mortality of pneumonia in cirrhotic patients with ascites. BMC Gastroenterol 2013;13:25.
4 Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, et al. Bacterial infections in cirrhosis: A position statement based on the EASL special conference 2013. J Hepatol 2014;60:1310-24.
5 Bajaj JS, O'Leary JG, Wong F, Reddy KR, Kamath PS. Bacterial infections in end-stage liver disease: Current challenges and future directions. Gut 2012;61:1219-25.
6 Preveden T. Bacterial infections in patients with liver cirrhosis. Med Pregl 2015;68:187-91.
7 Bajpai V, Gupta E, Kundu N, Kumar S, Maiwal R. Influenza A/H1N1pdm 09 infection in liver disease patients requiring ICU care. Indian J Health Sci Care 2018;5:109.
8 Premkumar M, Devurgowda D, Dudha S, Maiwall R, Bihari C, Grover S, et al. A/H1N1/09 influenza is associated with high mortality in liver cirrhosis. J Clin Exp Hepatol 2019;9:162-70.
9 Marzano A, Marengo A, Ruggiero T, Allice T, Sanna C, Alessandria C, et al. Clinical impact of A/H1/N1/09 influenza in patients with cirrhosis: Experience from a nosocomial cluster of infection. J Med Virol 2013;85:1-7.
10 Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society. Clin Infect Dis 2016;63:e61-e111.
11 Hakki M, Strasfeld LM, Townes JM. Predictive value of testing nasopharyngeal samples for respiratory viruses in the setting of lower respiratory tract disease. J Clin Microbiol 2014;52:4020-2.
12 Kim ES, Park KU, Lee SH, Lee YJ, Park JS, Cho YJ, et al. Comparison of viral infection in healthcare-associated pneumonia (HCAP) and community-acquired pneumonia (CAP). PLoS One 2018;13:e0192893.
13 Wiemken T, Peyrani P, Bryant K, Kelley RR, Summersgill J, Arnold F, et al. Incidence of respiratory viruses in patients with community-acquired pneumonia admitted to the intensive care unit: Results from the severe influenza pneumonia surveillance (SIPS) project. Eur J Clin Microbiol Infect Dis 2013;32:705-10.
14 Bal CK, Bhatia V, Kumar S, Saini D, Khillan V, Gupta E, et al. Influenza A/H1/N1/09 infection in patients with cirrhosis has a poor outcome: A case series. Indian J Gastroenterol 2014;33:178-82.
15 Althouse BM, Flasche S, Minh LN, Thiem VD, Hashizume M, Ariyoshi K, et al. Seasonality of respiratory viruses causing hospitalizations for acute respiratory infections in children in Nha Trang, Vietnam. Int J Infect Dis 2018;75:18-25.
16 Hoffmann J, Machado D, Terrier O, Pouzol S, Messaoudi M, Basualdo W, et al. Viral and bacterial co-infection in severe pneumonia triggers innate immune responses and specifically enhances IP-10: A translational study. Sci Rep 2016;6:38532.
17 Bellinghausen C, Rohde GG, Savelkoul PH, Wouters EF, Stassen FR. Viral-bacterial interactions in the respiratory tract. J Gen Virol 2016;97:3089-102.
18 Morris DE, Cleary DW, Clarke SC. Secondary bacterial infections associated with influenza pandemics. Front Microbiol 2017;8:1041.