Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
J Clin Virol. 2022 Jun;150-151:105152. doi: 10.1016/j.jcv.2022.105152. Epub 2022 Apr 4.
Some respiratory viruses have been evaluated for the association between viral burden and respiratory disease progression in hematopoietic cell transplant (HCT) recipients, and no significant association has been reported.
To assess whether initial viral burden of respiratory viruses predicts risk of progression to lower respiratory tract infection (LRTI) among adult allogeneic HCT recipients who presented with upper respiratory tract infection (URTI) with 12 viruses in the PCR era.
We reviewed adult allogeneic HCT recipients (4/2008-9/2018) who presented with their first symptomatic respiratory viral infection following transplantation at the Fred Hutchinson Cancer Center. Cox proportional hazards models were used to investigate whether viral burden as measured by initial Ct values at the diagnosis of URTI is associated with progression to LRTI within 90 days for each virus, treating death as a competing risk.
Among 2,148 adult HCT recipients during the study periods, 1,102 episodes of URTI met the study inclusion criteria. Higher viral burden (lower Ct value) were associated with an increased risk of progression to LRTI for influenza after adjusting for immunodeficiency scoring index and initiation of antiviral therapy, respectively. The association between viral burden and progression to LRTI was not found for other viruses.
Our findings suggest that routine reporting of viral burden in current molecular diagnostic platforms may be beneficial. Further studies are needed to investigate the impact of viral burden on LRTI in other populations including pediatric HCT recipients.
已有研究评估了造血细胞移植（HCT）受者呼吸道病毒载量与呼吸道疾病进展之间的相关性，但尚未发现显著相关性。
评估在 PCR 时代，成人异基因 HCT 受者发生上呼吸道感染（URTI）时，12 种呼吸道病毒的初始病毒载量是否可预测其发展为下呼吸道感染（LRTI）的风险。
我们回顾了在弗雷德哈钦森癌症研究中心接受移植后首次出现症状性呼吸道病毒感染的成年异基因 HCT 受者（2008 年 4 月至 2018 年 9 月）。使用 Cox 比例风险模型来研究 URTI 诊断时初始 Ct 值所衡量的病毒载量是否与 90 天内 LRTI 进展相关，将死亡视为竞争风险。
在研究期间的 2148 名成年 HCT 受者中，有 1102 例 URTI 符合研究纳入标准。调整免疫缺陷评分指数和抗病毒治疗的启动后，流感病毒载量（Ct 值越低）与 LRTI 进展风险增加相关。对于其他病毒，并未发现病毒载量与 LRTI 进展之间存在关联。
我们的研究结果表明，当前分子诊断平台中常规报告病毒载量可能是有益的。需要进一步研究来评估病毒载量对包括儿科 HCT 受者在内的其他人群中 LRTI 的影响。
