Factors Predicting Respiratory Viral Disease Progression in HCT Recipients

Ogimi C, Xie H, Waghmare A, et al. Novel Factors to Predict Respiratory Viral Disease Progression in Allogeneic Hematopoietic Cell Transplant Recipients. Bone Marrow Transplantation. 2022; 288 (doi: 10.1038/s41409-022-01575-z).

New research identifies novel risk factors for respiratory viral disease progression to lower respiratory tract infection (LRTI) among hematopoietic cell transplant (HCT) recipients, including a history of multiple transplants and hyperglycemia. The immunodeficiency scoring index (ISI) and several risk factors may predict disease progression for a number of viruses, the researchers report. The retrospective analysis sought to evaluate the likelihood of LRTI development by virus type and compare the performance of a simplified scoring system based on readily available criteria. The study included 1,027 patients (216 children and 811 adults) who had undergone HCT and presented with URTI, analyzing the first respiratory virus detected by multiplex PCR. In all, 18% (189 patients) developed a LRTI over a median of 12 days. In multivariable models, factors associated with a higher risk of progression to LRTI include a history of >1 transplant, age ≥40 years, time post-HCT (≤30 days), systemic steroids, hypoalbuminemia, hyperglycemia, cytopenia, and high ISI (scores 7-12). Progression risk was highest in the presence of respiratory syncytial virus and human metapneumovirus, and highly likely in patients with ≥3 independent risk factors or high ISI scores. The findings significantly increase the ability to identify HCT patients at risk for progression to LRTI and suggest a potential opportunity for intervention, including glycemic control, the researchers conclude.

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