在异基因造血干细胞移植中建立前瞻性临床社区获得性呼吸道病毒监测计划的临床获益。
The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation.
机构信息
Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain.
Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
出版信息
J Infect. 2020 Mar;80(3):333-341. doi: 10.1016/j.jinf.2019.12.022. Epub 2020 Jan 20.
BACKGROUND
There is a lack of studies comparing clinical outcomes among retrospective versus prospective cohorts of allogeneic stem cell transplant (allo-HCT) recipients with community acquired respiratory virus (CARV) infections.
METHODS
We compare outcomes in two consecutive cohorts of allo-HCT recipients with CARV infections. The retrospective cohort included 63 allo-HCT recipients with 108 CARV infections from January 2013 to April 2016 who were screened and managed following standard clinical practice based on influenza and respiratory syncytial virus rapid antigen detection methods. The prospective cohort was comprised of 144 consecutive recipients with 297 CARV episodes included in a prospective interventional clinical surveillance program (ProClinCarvSur-P) based on syndromic multiplex PCR as first-line test from May 2016 to December 2018 at a single transplant center.
RESULTS
CARV infections in the retrospective cohort showed more severe clinical features at the time of diagnosis compared to the prospective cohort (fever 83% vs. 57%, hospital admission 69% vs. 28% and lower respiratory tract 58% vs. 31%, respectively, p ≤ 0.002 for all comparisons). Antiviral therapy was more commonly prescribed in the prospective cohort (69 vs. 43 treated CARV episodes), particularly at the upper respiratory tract disease stage (34 vs. 12 treated CARV episodes). Three-month all-cause mortality was significantly higher in the retrospective cohort (n = 23, 37% vs. n = 10, 7%, p < 0.0001). Multivariate logistic regression analysis showed that recipients included in ProClinCarvSur-P had lower mortality rate [odds ratio 0.31, 95% confidence interval 0.12-0.7, p = 0.01].
CONCLUSION
This study report on outcome differences when reporting retrospective vs. prospective CARV infections after allo-HCT. Recipients included in a ProClinCarvSur-P had lower mortality.
背景
在回顾性队列和前瞻性队列的异基因造血干细胞移植（allo-HCT）受者中，社区获得性呼吸道病毒（CARV）感染的临床结局比较研究相对较少。
方法
我们比较了两批连续的 allo-HCT 受者伴有 CARV 感染的结局。回顾性队列纳入了 2013 年 1 月至 2016 年 4 月期间的 63 例 allo-HCT 受者的 108 例 CARV 感染病例，这些患者根据流感和呼吸道合胞病毒快速抗原检测方法，按照标准临床实践进行筛查和管理。前瞻性队列包括 2016 年 5 月至 2018 年 12 月期间在一家移植中心进行的一项基于综合征的多重 PCR 的前瞻性干预性临床监测计划（ProClinCarvSur-P）中连续纳入的 144 例连续受者的 297 例 CARV 发作。
结果
与前瞻性队列相比，回顾性队列的 CARV 感染在诊断时具有更严重的临床特征（分别为 83%和 57%发热，69%和 28%住院，58%和 31%下呼吸道，所有比较 p 值均≤0.002）。前瞻性队列更常开具抗病毒治疗（69 例与 43 例 CARV 治疗病例），尤其是在上呼吸道疾病阶段（34 例与 12 例 CARV 治疗病例）。回顾性队列的 3 个月全因死亡率明显更高（n=23，37% vs n=10，7%，p<0.0001）。多变量逻辑回归分析显示，纳入 ProClinCarvSur-P 的受者死亡率较低[比值比 0.31，95%置信区间 0.12-0.7，p=0.01]。
结论
本研究报告了 allo-HCT 后报告回顾性与前瞻性 CARV 感染时结局的差异。纳入 ProClinCarvSur-P 的受者死亡率较低。
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