Jean-Christophe Richard , Emilie Frobert , Grégory Destras , Hodane Yonis , Mehdi Mezidi , Francois Dhelft , Sophie Trouillet-Assant , Paul Bastard , Adrian Gervais , William Danjou , Frederic Aubrun , Fanny Roumieu , Jean-Marc Labaune , Laurence Josset , Antonin Bal , Bruno Simon , Jean-Laurent Casanova , Bruno Lina , Jean-Charles Picaud , Corinne Dupont , Laurent Bitker
{"title":"妊娠期与COVID-19相关的急性呼吸衰竭的病毒学和临床特征:一项病例对照研究","authors":"Jean-Christophe Richard , Emilie Frobert , Grégory Destras , Hodane Yonis , Mehdi Mezidi , Francois Dhelft , Sophie Trouillet-Assant , Paul Bastard , Adrian Gervais , William Danjou , Frederic Aubrun , Fanny Roumieu , Jean-Marc Labaune , Laurence Josset , Antonin Bal , Bruno Simon , Jean-Laurent Casanova , Bruno Lina , Jean-Charles Picaud , Corinne Dupont , Laurent Bitker","doi":"10.51893/2022.3.OA3","DOIUrl":null,"url":null,"abstract":"<div><p><strong>Objective:</strong> Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy.</p><p><strong>Design:</strong> Single-centre, retrospective observational case–control study.</p><p><strong>Setting:</strong> Adult level 3 ICU in a French university hospital.</p><p><strong>Participants:</strong> Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia.</p><p><strong>Main outcome measure:</strong> The primary endpoint of the study was viral load in pregnant and non-pregnant patients.</p><p><strong>Results:</strong> 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; <em>P</em> < 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 <em>v</em> 35%; <em>P</em> < 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not.</p><p><strong>Conclusions:</strong> Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000522/pdfft?md5=49a5cc3dcca58584edadc7a6c84a3015&pid=1-s2.0-S1441277223000522-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study\",\"authors\":\"Jean-Christophe Richard , Emilie Frobert , Grégory Destras , Hodane Yonis , Mehdi Mezidi , Francois Dhelft , Sophie Trouillet-Assant , Paul Bastard , Adrian Gervais , William Danjou , Frederic Aubrun , Fanny Roumieu , Jean-Marc Labaune , Laurence Josset , Antonin Bal , Bruno Simon , Jean-Laurent Casanova , Bruno Lina , Jean-Charles Picaud , Corinne Dupont , Laurent Bitker\",\"doi\":\"10.51893/2022.3.OA3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p><strong>Objective:</strong> Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy.</p><p><strong>Design:</strong> Single-centre, retrospective observational case–control study.</p><p><strong>Setting:</strong> Adult level 3 ICU in a French university hospital.</p><p><strong>Participants:</strong> Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia.</p><p><strong>Main outcome measure:</strong> The primary endpoint of the study was viral load in pregnant and non-pregnant patients.</p><p><strong>Results:</strong> 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; <em>P</em> < 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 <em>v</em> 35%; <em>P</em> < 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not.</p><p><strong>Conclusions:</strong> Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.</p></div>\",\"PeriodicalId\":49215,\"journal\":{\"name\":\"Critical Care and Resuscitation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2022-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1441277223000522/pdfft?md5=49a5cc3dcca58584edadc7a6c84a3015&pid=1-s2.0-S1441277223000522-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care and Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1441277223000522\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1441277223000522","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study
Objective: Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy.
Setting: Adult level 3 ICU in a French university hospital.
Participants: Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia.
Main outcome measure: The primary endpoint of the study was viral load in pregnant and non-pregnant patients.
Results: 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; P < 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 v 35%; P < 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not.
Conclusions: Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.
期刊介绍：
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
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