Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania.
Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania.
J Pediatric Infect Dis Soc. 2018 Dec 3;7(4):275-282. doi: 10.1093/jpids/pix051.
Respiratory virus infections (RVIs) pose a threat to children undergoing hematopoietic stem cell transplantation (HSCT). In this era of sensitive molecular diagnostics, the incidence and outcome of HSCT recipients who are hospitalized with RVI (H-RVI) are not well described.
A retrospective observational cohort of pediatric HSCT recipients (between January 2010 and June 2013) was assembled from 9 US pediatric transplant centers. Their medical charts were reviewed for H-RVI events within 1 year after their transplant. An H-RVI diagnosis required respiratory signs or symptoms plus viral detection (human rhinovirus/enterovirus, human metapneumovirus, influenza, parainfluenza, coronaviruses, and/or respiratory syncytial virus). The incidence of H-RVI was calculated, and the association of baseline HSCT factors with subsequent pulmonary complications and death was assessed.
Among 1560 HSCT recipients, 259 (16.6%) acquired at least 1 H-RVI within 1 year after their transplant. The median age of the patients with an H-RVI was lower than that of patients without an H-RVI (4.8 vs 7.1 years; P < .001). Among the patients with a first H-RVI, 48% required some respiratory support, and 14% suffered significant pulmonary sequelae. The all-cause and attributable case-fatality rates within 3 months of H-RVI onset were 11% and 5.4%, respectively. Multivariate logistic regression revealed that H-RVI onset within 60 days of HSCT, steroid use in the 7 days before H-RVI onset, and the need for respiratory support at H-RVI onset were associated with subsequent morbidity or death.
Results of this multicenter cohort study suggest that H-RVIs are relatively common in pediatric HSCT recipients and contribute to significant morbidity and death. These data should help inform interventional studies specific to each viral pathogen.
呼吸道病毒感染（RVIs）对接受造血干细胞移植（HSCT）的儿童构成威胁。在这个敏感的分子诊断时代，住院接受呼吸道病毒感染（H-RVI）的 HSCT 受者的发病率和结局尚未得到很好的描述。
我们从美国 9 家儿科移植中心组建了一个回顾性观察性儿科 HSCT 受者队列（2010 年 1 月至 2013 年 6 月期间）。对他们在移植后 1 年内的 H-RVI 事件进行了病历回顾。H-RVI 的诊断需要呼吸道症状或体征加上病毒检测（人鼻病毒/肠道病毒、人偏肺病毒、流感、副流感、冠状病毒和/或呼吸道合胞病毒）。计算了 H-RVI 的发生率，并评估了基线 HSCT 因素与随后的肺部并发症和死亡的相关性。
在 1560 名 HSCT 受者中，259 名（16.6%）在移植后 1 年内至少发生了 1 次 H-RVI。发生 H-RVI 的患者的中位年龄低于未发生 H-RVI 的患者（4.8 岁比 7.1 岁；P<.001）。在首次发生 H-RVI 的患者中，48%需要某种呼吸支持，14%患有明显的肺部后遗症。H-RVI 发病后 3 个月的全因和归因病死率分别为 11%和 5.4%。多变量逻辑回归显示，HSCT 后 60 天内发生 H-RVI、H-RVI 发病前 7 天内使用类固醇以及 H-RVI 发病时需要呼吸支持与随后的发病率或死亡率相关。
这项多中心队列研究的结果表明，H-RVIs 在儿科 HSCT 受者中较为常见，导致发病率和死亡率显著增加。这些数据应该有助于为每种病毒病原体的干预研究提供信息。
