Clinical characteristics and risk of adverse outcome in acute viral respiratory infections in the first year after hematopoietic stem cell transplantation. 8-year pre-COVID-19 cohort.

Abstract

Background: Hematopoietic stem cell transplant (HSCT) recipients are particularly vulnerable to acute viral respiratory infections (VRI), which can progress from upper respiratory tract infection (URTI) to acute lower respiratory infection (ALRI) and death. Aim: To identify factors associated with an unfavorable evolution in adults with acute VRI within one year after HSCT. Methods: A retrospective cohort at the Hospital Italiano de Buenos Aires (2011-2019). All events with positive viral panel by PCR were included. The outcomes were clinical status (WHO scale), progression from URTI to ALRI, admission to the ICU, and 30-day mortality. Bivariate and ordinal logistic regression models were applied. Results: 144 acute VRI were confirmed in 99 individuals. At diagnosis, 57% were hospitalized and 21% were outpatients with functional impairment; on day 7, 8.3% remained in the ICU. 53.5% presented as URTI, with 16.9% progression to ALRI. 16% required ICU care and 11% advanced life support. The 30-day mortality rate was 2.1%. Age >65 years, allogeneic transplantation, total body irradiation, use of corticosteroids, neutropenia, or lymphopenia were associated with a worse clinical status. Progression to ALRI was higher in women, in early post-HSCT events, and in hospitalized patients. Conclusion: Identifying risk groups can optimize prevention and support in post-HSCT acute VRI.