The clinical outcomes of COVID-19 critically ill patients co-infected with other respiratory viruses: a multicenter, cohort study

Abstract

Background Previous studies have shown that non-critically ill COVID-19 patients co-infected with other respiratory viruses have poor clinical outcomes. However, limited studies focused on this co-infections in critically ill patients. This study aims to evaluate the clinical outcomes of critically ill patients infected with COVID-19 and co-infected by other respiratory viruses. Methods A multicenter retrospective cohort study was conducted for all adult patients with COVID-19 who were hospitalized in the ICUs between March, 2020 and July, 2021. Eligible patients were sub-categorized into two groups based on simultaneous co-infection with other respiratory viruses throughout their ICU stay. Influenza A or B, Human Adenovirus (AdV), Human Coronavirus (i.e., 229E, HKU1, NL63, or OC43), Human Metapneumovirus, Human Rhinovirus/Enterovirus, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Parainfluenza virus, and Respiratory Syncytial Virus (RSV) were among the respiratory viral infections screened. Patients were followed until discharge from the hospital or in-hospital death. Results A total of 836 patients were included in the final analysis. Eleven patients (1.3%) were infected concomitantly with other respiratory viruses. Rhinovirus/Enterovirus (38.5%) was the most commonly reported co-infection. No difference was observed between the two groups regarding the 30-day mortality (HR 0.39, 95% CI 0.13, 1.20; p = 0.10). The in-hospital mortality was significantly lower among co-infected patients with other respiratory viruses compared with patients who were infected with COVID-19 alone (HR 0.32 95% CI 0.10, 0.97; p = 0.04). Patients concomitantly infected with other respiratory viruses had longer median mechanical ventilation (MV) duration and hospital length of stay (LOS). Conclusion Critically ill patients with COVID-19 who were concomitantly infected with other respiratory viruses had comparable 30-day mortality to those not concomitantly infected. Further proactive testing and care may be required in the case of co-infection with respiratory viruses and COVID-19. The results of our study need to be confirmed by larger studies.

Prevalence and clinical impact of mono- and co-infections with endemic coronaviruses 229E, OC43, NL63, and HKU-1 during the COVID-19 pandemic

“…Another study of ours reported a longer hospital stay in the remaining mixed infections of SARS-CoV-2 with other respiratory viruses, as along with a greater percentage of intensive treatments [ 23 ]. A similar trend has been reported in other studies [ 24 ]. Furthermore, participants who were co-infected with SARS-CoV-2 and eHCoV had approximately threefold higher CRP and lower saturation levels than those co-infected with other respiratory viruses.…”

“…In a previous study conducted by us, it was reported that individuals who were infected with both SARS-CoV-2 and another respiratory virus had a more severe clinical course and required more frequent hospitalisation or invasive treatment [ 23 ]. Other studies have also reported a more severe clinical picture in patients with COVID-19 who were co-infected [ [24] , [25] , [26] ]. Based on laboratory findings, imaging studies, and disease outcomes, some authors showed that co-infections do not aggravate the condition of the patient [ 27 ].…”

Survival implications vs. complications: unraveling the impact of vitamin D adjunctive use in critically ill patients with COVID-19—A multicenter cohort study

“…This study is part of the Saudi Critical Care Pharmacy Research (SCAPE) platform, which conducted several studies that evaluated the safety and effectiveness of multiple therapies in critically ill patients ( 18 ). The design of this multicenter cohort study is similar to previously published studies ( 19 – 25 ). The details of the study design are available in Supplementary material .…”

Exploring Metabolic Anomalies in COVID-19 and Post-COVID-19: A Machine Learning Approach with Explainable Artificial Intelligence

“…As of March 2024, the number of confirmed COVID-19 cases has surpassed 770 million 1 . The wide spectrum of symptoms, varying from mild to severe respiratory distress and multi-organ dysfunction 2 , underscores the need for a comprehensive systemic understanding of the disease's pathophysiology and the factors contributing to its diverse clinical outcomes 3,4 . In addition to the immediate health impacts, the COVID-19 pandemic has highlighted the long-lasting effects and challenges in the post-recovery phase.…”