Respiratory Syncytial Virus Lower Respiratory Disease in Hematopoietic Cell Transplant Recipients: Viral RNA Detection in Blood, Antiviral Treatment, and Clinical Outcomes
Respiratory Syncytial Virus Lower Respiratory Disease in Hematopoietic Cell Transplant Recipients: Viral RNA Detection in Blood, Antiviral Treatment, and Clinical Outcomes
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DOI：
10.1093/cid/cit639
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发表时间：
2013-12-15
影响因子：
11.8
通讯作者：
Boeckh, Michael
中科院分区：
文献类型：
--
作者：
Waghmare, Alpana;Campbell, Angela P.;Boeckh, Michael
背景造血细胞移植（HCT）后呼吸道合胞病毒（RSV）肺炎与严重的发病率相关。尽管在HCT后RSV下呼吸道疾病（LRD）患者的血清中检测到RSV RNA，但尚未在多变量模型中充分确定其与临床结局的相关性。此外，抗病毒治疗在HCT接受者中的作用以前没有在多变量模型中进行过分析。我们回顾性地确定了病毒学证实的RSV LRD的HCT接受者，并通过定量逆转录聚合酶链反应检测了储存的血浆/血清样本中的RSV RNA。使用多变量考克斯模型分析RSV RNA检测的危险因素以及血清中RSV RNA和抗病毒治疗对结局的影响。在HCT后中位24.5天和LRD后2天，在92例患者中的28例（30%）的血浆或血清中检测到RSV RNA。在多变量模型中，中性粒细胞减少症、单核细胞减少症、血小板减少症和机械通气增加了血浆/血清RSV RNA检测的风险;淋巴细胞减少症和类固醇使用没有增加。在多变量模型中，RSV RNA检测增加了总死亡率的风险（校正的风险比[aHR]，2.09 [P =.02]），而雾化利巴韦林治疗降低了总死亡率和肺死亡的风险（aHR，分别为0.33 [P =.001]和0.31 [P =.003]）。血浆或血清中的RSV RNA检测可能是RSV LRD HCT接受者肺损伤和不良结局的标志物。雾化利巴韦林治疗似乎对总体死亡率和肺死亡率有保护作用。
Background. Respiratory syncytial virus (RSV) pneumonia after hematopoietic cell transplant (HCT) is associated with severe morbidity. Although RSV RNA has been detected in serum from patients with RSV lower respiratory disease (LRD) after HCT, the association with clinical outcomes has not been well established in multivariable models. Additionally, the role of antiviral treatment in HCT recipients has not been previously analyzed in multivariable models.Methods. We retrospectively identified HCT recipients with virologically confirmed RSV LRD and tested stored plasma/serum samples by quantitative reverse transcription polymerase chain reaction for RSV RNA. Risk factors for RSV RNA detection and the impact of RSV RNA in serum and antiviral therapy on outcomes were analyzed using multivariable Cox models.Results. RSV RNA was detected in plasma or serum from 28 of 92 (30%) patients at a median of 24.5 days following HCT and 2 days following LRD. In multivariable models, neutropenia, monocytopenia, thrombocytopenia, and mechanical ventilation increased the risk of plasma/serum RSV RNA detection; lymphopenia and steroid use did not. RSV RNA detection increased the risk of overall mortality in multivariable models (adjusted hazard ratio [aHR], 2.09 [P = .02]), whereas treatment with aerosolized ribavirin decreased the risk of overall mortality and pulmonary death (aHR, 0.33 [P = .001] and aHR 0.31 [P = .003], respectively).Conclusions. RSV RNA detection in plasma or serum may be a marker for lung injury and poor outcomes in HCT recipients with RSV LRD. Treatment with aerosolized ribavirin appeared to be protective against overall and pulmonary mortality.