Respiratory viral infections by Non-influenza viruses are associated with more adverse clinical outcome in patients with underlying liver disease: a single centre laboratory based study

  1. Ekta Gupta
  2. Abhishek Padhi
  3. Kavita Agarwal
  4. Krithiga Ramachandran
  5. Reshu Agarwal
  6. Samba Siva Rao Pasupuleti
  7. Debajyoti Bhattacharyya
  8. Rakhi Maiwall
  9. Shiv Kumar Sarin

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

Respiratory viral infections are an important cause of acute respiratory tract infections. They are caused by both Influenza and non influenza viruses. Respiratory viral infections are known to be associated with severe clinical outcome especially in the critically ill. A constant surveillance is needed for early etiological identification which can help in timely and appropriate management and will further help in prevention of indiscriminate use of antibiotics in patients with viral etiology.

Methods

In this retrospective study, clinical records of all adult liver disease patients with clinically confirmed ARI, whose request for respiratory viral testing were received in the virology laboratory during September 2016 - March 2019 were reviewed. Respiratory viruses were identified by real time PCR on FilmArray 2.0 instrument (BioFire Diagnostics, Utah, USA) using Respiratory panel as per the manufacturer’s instructions.

Results

Of the 603 patients of liver disease with clinically confirmed influenza like illness, over all incidence of respiratory viral infection was 24.3% (n= 147). Infections by non-influenza viruses (87, 59.1%) were more than influenza group of viruses. Mortality was higher in non influenza group (43, 49.4%) as compared to influenza (24, 40%) [p=0.015] being maximum in Rhinovirus, 22 (32.8%). Two peaks were observed in both influenza and non influenza groups, first in the months of January and February and the other one in August and October.

Conclusion

With the emergence of SARS-CoV-2 it has now become imperative for a constant surveillance of the non influenza viruses for early etiological identification of the respiratory viral infection for proper and timely management in the critically ill.

Highlights

  • Patients with liver cirrhosis having Respiratory viral infections have a poor outcome in terms of morbidity and mortality.

  • Mortality associated with non influenza viruses (NIV) is more as compared to influenza virus infections.

  • COVID-19 pandemic and higher mortality in NIVs warrants a constant monitoring of respiratory viral infections.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.08.01.20166330: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethics statement: The study was reviewed and approved by the Institutional Review Board, Institute of liver and biliary sciences, New Delhi (ILBS).
    Consent: The informed consent was waived by the Institutional Review Board because the study was based on the retrospective analysis of existing clinical data.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableChildren < 18 years of age, patients with frank immune-suppression, pregnant females, HIV infected and patients with hepato-cellular carcinoma or any other kind of cancer were excluded from this data.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The swabs along with the VTM were vortexed and about 300µl of the sample was taken up for testing for a panel of 21 different respiratory viruses by real time PCR on FilmArray 2.0 instrument (BioFire Diagnostics, Utah, USA) using Respiratory panel as per the manufacturer’s instructions [12].
    FilmArray
    suggested: None
    Statistical analyses were performed using the SPSS software version 25(IBM Inc., Chicago, IL, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study does have few limitations. Firstly, it is a single center laboratory based study where majority are known patients with liver ailments. Secondly The lack of a control population with no respiratory symptoms is another limitation that precludes any conclusion on the pathogenicity of NIRV. Despite these minor limitations our study adds significantly to the literature by contributing to better characterization of the burden of NIV in adult patients with liver cirrhosis.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.08.01.20166330v1 on medRxiv