ABSTRACT
Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been raging since the end of 2019 and has shown worse outcomes in solid organ transplant recipients (SOTR). The clinical differences as well as outcomes between these respiratory viruses have not been well defined in SOTR. Methods. This is a retrospective cohort study of adult SOTR with nasopharyngeal swab or bronchoalveolar lavage PCR positive for either SARS-CoV-2, non-SARSCoV-2 coronavirus, influenza, or respiratory syncytial virus (RSV) from January 2017 to October 2020;both inpatient and outpatient. The follow up period was up to three months. Clinical characteristics and outcomes were evaluated. Development of lower respiratory tract infection (LRTI) was defined as new pulmonary infiltrates with or without symptoms. For statistical analysis, Fischer's exact test and log rank test were performed. Results. During study period, 157 SARS-CoV-2, 72 non-SARS-CoV-2 coronavirus, 100 influenza, 50 RSV infections were identified. Patient characteristics and outcomes are shown in tables 1 and 2, respectively. Secondary infections were not statistically significantly different between SARS-CoV-2 vs. non-SARS-CoV-2 coronavirus and influenza (p=0.25, 0.56) respectively, while it was statistically significant between SARS-CoV-2 and RSV (p=0.0009). Development of LRTI was higher in SARS-CoV-2 when compared to non-SARS-CoV-2 coronavirus (p=0.03), influenza (p=0.0001) and RSV (p=0.003). Admission to ICU was higher with SARS-CoV-2 compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.0001) and RSV (p=0.007). SARS-CoV-2 also had higher rates of mechanical ventilation when compared to non-SARS-CoV-2 coronavirus (p=0.01), influenza (p=0.01) and RSV (p=0.03). With time to event analysis, higher mortality with SARS-CoV-2 as compared to non-SARSCoV-2 coronavirus, influenza, and RSV (p=0.01) was shown (Figure 1). Conclusion. We found higher incidence of ICU admission, mechanical ventilation, and mortality among SARS-CoV-2 SOTR vs other respiratory viruses. To validate these results, multicenter study is warranted.
ABSTRACT
Introduction: A respiratory illness caused by a novel coronavirus, the SARS-CoV-2 coronavirus, began in China in December 2019 and subsequently spread around the world. The efficacy of high-flow nasal cannula oxygen therapy (HFNC) is still unknown in patients with this disease. The principal aim of this research is to describe its utility as a therapy for the treatment of the Acute Respiratory Distress Syndrome (ARDS) caused by SARS-CoV-2 Methods: Retrospective analysis carried out from March 18 to April 18, 2020. 196 patients with bilateral pneumonia were admitted to our pulmonology unit during this period. 40 of them suffered from ARDS and were treated with HFNC in which whom intubation rate and mortality were analyzed. Results: Mean age was 58.9 years, and 70% were men. Twenty-one patients (52.5%) experienced therapy failure and required intubation, with a median time-to-intubation of 2 days (IQR: 1-4). After initiating HFNC, the Sp02/Fi02 ratio was significantly better in the group that did not require intubation (113.4±6.6 vs 93.7±6.7, p=0.020), as was the ROX index (5±1.6 vs 4±1, p=0.018). A ROX index less than 4.94 measured 2 to 6 hours after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 - 13.7];p=0.026). The overall mortality rate was nine patients (22.5%), all of whom were in the failed HFNC therapy group. Conclusions: High-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.