Journal Article

HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients

Meyer, Antoine, Abdel-Nabey, Moustafa, Ruckly, Stephane, Sayagh, Faiza, Descamps, Diane, Presente, Simona, de Montmollin, Etienne, Sonneville, Romain, Houhou-Fidouh, Nadhira, Girard, Tiphaine, Wicky, Paul-Henri, Buetti, Niccolò, Timsit, Jean-Francois, Jaquet, Pierre, Patrier, Juliette, Bouadma, Lila

2021

Overview

Background Data in the literature about HSV reactivation in COVID-19 patients are scarce, and the association between HSV-1 reactivation and mortality remains to be determined. Our objectives were to evaluate the impact of Herpes simplex virus (HSV) reactivation in patients with severe SARS-CoV-2 infections primarily on mortality, and secondarily on hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and intensive care unit-bloodstream infection (ICU-BSI). Methods We conducted an observational study using prospectively collected data and HSV-1 blood and respiratory samples from all critically ill COVID-19 patients in a large reference center who underwent HSV tests. Using multivariable Cox and cause-specific (cs) models, we investigated the association between HSV reactivation and mortality or healthcare-associated infections. Results Of the 153 COVID-19 patients admitted for ≥ 48 h from Feb-2020 to Feb-2021, 40/153 (26.1%) patients had confirmed HSV-1 reactivation (19/61 (31.1%) with HSV-positive respiratory samples, and 36/146 (24.7%) with HSV-positive blood samples. Day-60 mortality was higher in patients with HSV-1 reactivation (57.5%) versus without (33.6%, p  = 0.001). After adjustment for mortality risk factors, HSV-1 reactivation was associated with an increased mortality risk (hazard risk [HR] 2.05; 95% CI 1.16–3.62; p  = 0.01). HAP/VAP occurred in 67/153 (43.8%) and ICU-BSI in 42/153 (27.5%) patients. In patients with HSV-1 reactivation, multivariable cause-specific models showed an increased risk of HAP/VAP (csHR 2.38, 95% CI 1.06–5.39, p  = 0.037), but not of ICU-BSI. Conclusions HSV-1 reactivation in critically ill COVID-19 patients was associated with an increased risk of day-60 mortality and HAP/VAP.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Bacteremia / Bacterial pneumonia / Blood / Body temperature / Catheters / Chronic illnesses / Complications and side effects / Coronaviruses / COVID-19 / COVID-19 - mortality / COVID-19 - virology / Critical care / Critical Care Medicine / Critical Illness / Critically ill / Cytokines / Data analysis / Emergency Medicine / Herpes simplex / Herpes viruses / Herpesvirus 1, Human - physiology / HSV / Humans / Infections / Intensive / Medicine / Medicine & Public Health / Mortality / Patient outcomes / Pneumonia / Pneumonia - epidemiology / Pneumonia - virology / Risk Assessment / Risk factors / Severe acute respiratory syndrome coronavirus 2 / Steroids / Variables / Ventilators