Poor control of viral replication in the lung as major driver of early respiratory failure in ventilated patients with COVID-19
Year: 2025
Type: preprint
Study design: Observational Study
Abstract: The contribution of active SARS-CoV-2 viral replication to respiratory failure in severe COVID-19 remains unclear. We prospectively analysed bronchoalveolar lavage (BAL) samples from 159 critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) for SARS-CoV-2 RNA load, replication-competent virus and host immune gene expression. Viral RNA was detected in 84.3% of patients and 60% were positive for replication-competent virus. Viral culture positivity showed the strongest association with shorter time from symptom onset to IMV initiation. Despite robust type I/III interferon expression, immune effector responses were impaired, and only CXCL10 and PDL1 gene expression were associated with early respiratory failure. These findings underscore uncontrolled viral replication as a key driver of early respiratory failure in critically ill COVID-19 patients.
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Awards: G1550781393, G1756811526, IDENTIFICACIÓN DE LA PRE-SEPSIS MEDIANTE TECNOLOGÍAS PEA / ELLA-SIMPLEPLEX, G3742814325, G3895468693, G3975241840, Factores de riesgo, pronóstico personalizados y seguimiento a un año de los enfermos ingresados en las unidades de Cuidados Intensivos Españolas infectados por el virus COVID19: CIBERESUCICOVID
OpenAlex ID: W4413295937