Parainfluenza virus lower respiratory tract disease after hematopoietic cell transplant: viral detection in the lung predicts outcome.
Parainfluenza virus lower respiratory tract disease after hematopoietic cell transplant: viral detection in the lung predicts outcome.
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造血细胞移植后的副氟藻病毒下呼吸道疾病：肺中的病毒检测可以预测结果。
DOI：
10.1093/cid/ciu134
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发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
Boeckh M
中科院分区：
文献类型：
--
作者：
Seo S;Xie H;Campbell AP;Kuypers JM;Leisenring WM;Englund JA;Boeckh M
我们提出了一个新的定义下呼吸道疾病（LRTD）的基础上的病毒检测网站，与临床结果。单核细胞计数、氧气使用和高剂量类固醇使用与副流感病毒LRTD后的死亡率相关。 背景：副流感病毒（PIV）常感染造血细胞移植（HCT）后的患者，常引起下呼吸道疾病（LRTD）。 在评价HCT后PIV影响的研究中，LRTD的定义存在显著差异。 方法：我们回顾性评估了544例经实验室证实的PIV的HCT受者，并将LRTD分为3组：可能（上呼吸道PIV检测伴新发肺浸润伴/不伴LRTD症状）、可能（肺部PIV检测伴LRTD症状，不伴新发肺浸润）和证实（肺部PIV检测伴新发肺浸润伴/不伴LRTD症状）。 结果：在可能、很可能和确诊病例中，LRTD后90天生存率分别为87%、58%和45%。 与上呼吸道感染患者相比，可能和确诊的LRTD患者的生存率显著更差（可能：风险比[HR]，5.87 [P < .001];确诊：HR，9.23 [P < .001]），而可能的LRTD患者的生存率则没有显著差异（HR，1.49 [P = .27]）。在多变量分析中，在确诊/可能病例中，诊断时需氧量、低单核细胞计数和高剂量类固醇使用（>2 mg/kg/d）与高死亡率相关。 结论：与仅在上呼吸道样本中进行病毒检测的PIV LRTD（可能的LRTD）相比，在肺部进行病毒检测的PIV LRTD（证实的/可能的LRTD）与更差的结果相关。 这种新的分类应该会影响临床试验设计，并允许中心之间的结果具有可比性。
We propose a new definition of lower respiratory tract disease (LRTD) based on the viral detection site that correlates with clinical outcome. Monocyte count, oxygen use, and high-dose steroid use are associated with mortality after parainfluenza virus LRTD. Background. Parainfluenza virus (PIV) commonly infects patients following hematopoietic cell transplantation (HCT), frequently causing lower respiratory tract disease (LRTD). The definition of LRTD significantly differs among studies evaluating the impact of PIV after HCT. Methods. We retrospectively evaluated 544 HCT recipients with laboratory-confirmed PIV and classified LRTD into 3 groups: possible (PIV detection in upper respiratory tract with new pulmonary infiltrates with/without LRTD symptoms), probable (PIV detection in lung with LRTD symptoms without new pulmonary infiltrates), and proven (PIV detection in lung with new pulmonary infiltrates with/without LRTD symptoms). Results. Probabilities of 90-day survival after LRTD were 87%, 58%, and 45% in possible, probable, and proven cases, respectively. Patients with probable and proven LRTD had significantly worse survival than those with upper respiratory tract infection (probable: hazard ratio [HR], 5.87 [P < .001]; proven: HR, 9.23 [P < .001]), whereas possible LRTD did not (HR, 1.49 [P = .27]). Among proven/probable cases, oxygen requirement at diagnosis, low monocyte counts, and high-dose steroid use (>2 mg/kg/day) were associated with high mortality in multivariable analysis. Conclusions. PIV LRTD with viral detection in lungs (proven/probable LRTD) was associated with worse outcomes than was PIV LRTD with viral detection in upper respiratory samples alone (possible LRTD). This new classification should impact clinical trial design and permit comparability of results among centers.
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影响因子：
6.4
作者：
Cortez, KJ;Erdman, DD;Bennett, JE
通讯作者：
Bennett, JE
影响因子：
11.8
作者：
Ascioglu, S;Rex, JH;Walsh, TJ
通讯作者：
Walsh, TJ
DOI：
10.1093/cid/cis844
发表时间：
2013-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Hirsch HH;Martino R;Ward KN;Boeckh M;Einsele H;Ljungman P
通讯作者：
Ljungman P
影响因子：
20.3
作者：
Nichols, WG;Corey, L;Boeckh, M
通讯作者：
Boeckh, M
影响因子：
8
作者：
El Saleeby, Chadi M.;Somes, Grant W.;Gaur, Aditya H.
通讯作者：
Gaur, Aditya H.