血液系统恶性肿瘤成人患者呼吸道合胞病毒下呼吸道感染后死亡的危险因素。

Risk factors for mortality after respiratory syncytial virus lower respiratory tract infection in adults with hematologic malignancies.

作者信息

Vakil Erik, Sheshadri Ajay, Faiz Saadia A, Shah Dimpy P, Zhu Yayuan, Li Liang, Kmeid Joumana, Azzi Jacques, Balagani Amulya, Bashoura Lara, Ariza-Heredia Ella, Chemaly Roy F

机构信息

Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.

出版信息

Transpl Infect Dis. 2018 Dec;20(6):e12994. doi: 10.1111/tid.12994. Epub 2018 Sep 21.

BACKGROUND

Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) is associated with high mortality in patients with hematologic malignancies (HM). We sought to determine whether allogeneic hematopoietic cell transplant (allo-HCT) recipients would be at higher risk for 60-day mortality.

METHODS

We examined a retrospective cohort of adults with HM with or without HCT treated for RSV LRTI (n = 154) at our institution from 1996-2013. We defined possible RSV LRTI as RSV detected only in the upper respiratory tract with new radiologic infiltrates and proven RSV LRTI as RSV detected in BAL fluid with new radiologic infiltrates. Immunodeficiency Scoring Index (ISI) and Severe Immunodeficiency (SID) criteria were calculated for HCT recipients. Multivariable logistic regression analyses were performed to identify independent risk factors associated with 60-day all-cause mortality.

RESULTS

Mortality was high in HM patients (25%), but there was no difference between those without HCT, autologous or allo-HCT recipients in logistic regression models. Separate multivariate models showed that at RSV diagnosis, neutropenia (OR 8.3, 95% CI 2.8-24.2, P = 0.005) and lymphopenia (OR 3.7, 95% CI 1.7-8.2, P = 0.001) were associated with 60-day mortality. Proven LRTI was associated with higher 60-day mortality (neutropenia model: OR 4.7, 95%CI 1.7-13.5; lymphopenia model: OR 3.3, 95% CI 1.2-8.8), and higher ICU admission. In HCT recipients, high ISI and very severe immunodeficiency by SID criteria were associated with higher 60-day all-cause mortality.

CONCLUSIONS

Mortality is similarly high among HM patients without HCT and HCT recipients. High-grade immunodeficiency and detection of RSV from BAL fluid are associated with higher 60-day mortality.

背景

呼吸道合胞病毒（RSV）下呼吸道感染（LRTI）与血液系统恶性肿瘤（HM）患者的高死亡率相关。我们试图确定异基因造血细胞移植（allo-HCT）受者60天死亡率是否更高。

方法

我们对1996年至2013年在本机构接受RSV LRTI治疗的有或无HCT的成年HM患者进行了一项回顾性队列研究（n = 154）。我们将可能的RSV LRTI定义为仅在上呼吸道检测到RSV且有新的放射学浸润，将确诊的RSV LRTI定义为在BAL液中检测到RSV且有新的放射学浸润。计算了HCT受者的免疫缺陷评分指数（ISI）和严重免疫缺陷（SID）标准。进行多变量逻辑回归分析以确定与60天全因死亡率相关的独立危险因素。

结果

HM患者的死亡率很高（25%），但在逻辑回归模型中，未接受HCT的患者、自体或allo-HCT受者之间没有差异。单独的多变量模型显示，在RSV诊断时，中性粒细胞减少（OR 8.3，95% CI 2.8 - 24.2，P = 0.005）和淋巴细胞减少（OR 3.7，95% CI 1.7 - 8.2，P = 0.001）与60天死亡率相关。确诊的LRTI与更高的60天死亡率相关（中性粒细胞减少模型：OR 4.7，95%CI 1.7 - 13.5；淋巴细胞减少模型：OR 3.3，95% CI 1.2 - 8.8），且与更高的ICU入院率相关。在HCT受者中，高ISI和根据SID标准的非常严重免疫缺陷与更高的60天全因死亡率相关。