Các yếu tố nguy cơ gây nhiễm trùng đường hô hấp dưới do coronavirus mùa ở bệnh nhân ghép tế bào huyết học

Blood Advances - Tập 5 - Trang 1903-1914 - 2021
Chikara Ogimi1,2,3, Hu Xie4, Alpana Waghmare1,3, Masumi Ueda Oshima4,5, Kanwaldeep K. Mallhi2,4, Keith R. Jerome3,6, Wendy M. Leisenring4, Janet A. Englund1,2, Michael Boeckh3,4,7
1Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, WA
2Department of Pediatrics, University of Washington, Seattle, WA
3Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
4Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
5Division of Medical Oncology, University of Washington, Seattle, WA
6Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
7Department of Medicine, University of Washington, Seattle, WA

Tóm tắt

Tóm tắt Dữ liệu còn hạn chế về các yếu tố nguy cơ gây nhiễm trùng đường hô hấp dưới (LRTI) do coronavirus mùa (HCoVs) ở người và ý nghĩa của việc ghi nhận vi sinh vật bằng rửa phế quản phổi (BAL) đối với kết quả ở những người nhận ghép tế bào huyết học (HCT). Chúng tôi đã tiến hành phân tích hồi cứu các bệnh nhân trải qua ghép tế bào HCT đồng loại (4/2008-9/2018) có HCoV (OC43/NL63/HKU1/229E) được phát hiện thông qua phản ứng chuỗi polymerase trong quá trình chuẩn bị hoặc sau khi ghép. Các yếu tố nguy cơ cho tất cả các biểu hiện của LRTI cũng như sự tiến triển từ nhiễm trùng đường hô hấp trên (URTI) có HCoV sang LRTI đã được phân tích bằng hồi quy logistic và mô hình tỷ lệ nguy cơ Cox, tương ứng. Tỷ lệ tử vong sau LRTI do HCoV đã được so sánh theo cách ghi nhận vi sinh học bằng BAL. Tổng cộng có 297 bệnh nhân (61 trẻ em và 236 người lớn) phát triển nhiễm trùng HCoV, cụ thể là: 254 bệnh nhân chỉ có URTI, 18 bệnh nhân có LRTI, và 25 bệnh nhân tiến triển từ URTI sang LRTI (trung vị, 16 ngày; khoảng, 2-62 ngày). Phân tích hồi quy logistic đa biến cho thấy rằng giới tính nam, chỉ số suy giảm miễn dịch cao hơn, albumin <3 g/dL, glucose >150 mg/dL, và sự hiện diện của các tác nhân gây bệnh đồng nhiễm hô hấp có liên quan đến sự xuất hiện của LRTI. Tăng glucose với việc sử dụng steroid có liên quan đến sự tiến triển đến LRTI (P < .01) trong các mô hình Cox. LRTI với HCoV được phát hiện trong BAL có tỷ lệ tử vong cao hơn so với LRTI không có ghi nhận trong BAL (P < .01). Tổng kết lại, chúng tôi đã xác định được các yếu tố liên quan đến LRTI do HCoV, một số trong số đó ít được nhận biết là yếu tố nguy cơ cho LRTI do các virus hô hấp khác ở người nhận HCT. Mối liên hệ giữa tăng glucose và LRTI có thể cung cấp cơ hội can thiệp để giảm rủi ro LRTI.

Từ khóa

#LRTI #HCoVs #HCT #yếu tố nguy cơ #glucose #BAL #tử vong

Tài liệu tham khảo

ElGohary, The risk and prognosis of COVID-19 infection in cancer patients: a systematic review and meta-analysis [published online ahead of print 30 July 2020], Hematol Oncol Stem Cell Ther Greenberg, 2016, Update on human rhinovirus and coronavirus infections, Semin Respir Crit Care Med, 37, 555, 10.1055/s-0036-1584797 Ogimi, 2017, Clinical significance of human coronavirus in bronchoalveolar lavage samples from hematopoietic cell transplant recipients and patients with hematologic malignancies, Clin Infect Dis, 64, 1532, 10.1093/cid/cix160 Piñana, Seasonal human coronaviruses respiratory tract infection in recipients of allogeneic hematopoietic stem cell transplantation [published online ahead of print 29 August 2020], J Infect Dis Eichenberger, 2019, Incidence, significance, and persistence of human coronavirus infection in hematopoietic stem cell transplant recipients, Bone Marrow Transplant, 54, 1058, 10.1038/s41409-018-0386-z Shah, 2020, Favorable outcomes of COVID-19 in recipients of hematopoietic cell transplantation, J Clin Invest, 130, 6656, 10.1172/JCI141777 Seo, 2016, Human metapneumovirus infections following hematopoietic cell transplantation: factors associated with disease progression, Clin Infect Dis, 63, 178, 10.1093/cid/ciw284 Campbell, 2015, Clinical outcomes associated with respiratory virus detection before allogeneic hematopoietic stem cell transplant, Clin Infect Dis, 61, 192, 10.1093/cid/civ272 Kuypers, 2006, Comparison of real-time PCR assays with fluorescent-antibody assays for diagnosis of respiratory virus infections in children, J Clin Microbiol, 44, 2382, 10.1128/JCM.00216-06 Kuypers, 2007, Clinical disease in children associated with newly described coronavirus subtypes, Pediatrics, 119, e70, 10.1542/peds.2006-1406 Xu, 2013, Implementation of filmarray respiratory viral panel in a core laboratory improves testing turnaround time and patient care, Am J Clin Pathol, 139, 118, 10.1309/AJCPH7X3NLYZPHBW Seo, 2014, Parainfluenza virus lower respiratory tract disease after hematopoietic cell transplant: viral detection in the lung predicts outcome, Clin Infect Dis, 58, 1357, 10.1093/cid/ciu134 Waghmare, 2019, Human rhinovirus infections in hematopoietic cell transplant recipients: risk score for progression to lower respiratory tract infection, Biol Blood Marrow Transplant, 25, 1011, 10.1016/j.bbmt.2018.12.005 Hammer, 2009, The contribution of malglycemia to mortality among allogeneic hematopoietic cell transplant recipients, Biol Blood Marrow Transplant, 15, 344, 10.1016/j.bbmt.2008.12.488 Shah, 2014, Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections, Blood, 123, 3263, 10.1182/blood-2013-12-541359 Waghmare, 2016, How I treat respiratory viral infections in the setting of intensive chemotherapy or hematopoietic cell transplantation, Blood, 127, 2682, 10.1182/blood-2016-01-634873 Jung, 2014, The impact of hyperglycemia on risk of severe infections during early period of induction therapy in patients with newly diagnosed multiple myeloma, BioMed Res Int, 2014, 413149, 10.1155/2014/413149 Sopfe, 2019, Malglycemia is associated with poor outcomes in pediatric and adolescent hematopoietic stem cell transplant patients, Blood Adv, 3, 350, 10.1182/bloodadvances.2018021014 Cai, 2020, Fasting blood glucose level is a predictor of mortality in patients with COVID-19 independent of diabetes history, Diabetes Res Clin Pract, 169, 108437, 10.1016/j.diabres.2020.108437 Goyal, 2020, Proposed guidelines for screening of hyperglycemia in patients hospitalized with COVID-19 in low resource settings, Diabetes Metab Syndr, 14, 753, 10.1016/j.dsx.2020.05.039 Singh, 2020, Hyperglycemia without diabetes and new-onset diabetes are both associated with poorer outcomes in COVID-19, Diabetes Res Clin Pract, 167, 108382, 10.1016/j.diabres.2020.108382 Hulme, 2017, Influenza virus and glycemic variability in diabetes: a killer combination?, Front Microbiol, 8, 861, 10.3389/fmicb.2017.00861 Reading, 1998, Increased susceptibility of diabetic mice to influenza virus infection: compromise of collectin-mediated host defense of the lung by glucose?, J Virol, 72, 6884, 10.1128/JVI.72.8.6884-6887.1998 Xiu, 2014, Stress hyperglycemia, insulin treatment, and innate immune cells, Int J Endocrinol, 2014, 486403, 10.1155/2014/486403 Wijsman, 2012, Responsiveness of the innate immune system and glucose concentrations in the oldest old, Age (Dordr), 34, 983, 10.1007/s11357-011-9292-7 Wang, 2020, O-GlcNAc transferase promotes influenza A virus-induced cytokine storm by targeting interferon regulatory factor-5, Sci Adv, 6, eaaz7086, 10.1126/sciadv.aaz7086 Piñana, 2018, Epidemiologic and clinical characteristics of coronavirus and bocavirus respiratory infections after allogeneic stem cell transplantation: a prospective single-center study, Biol Blood Marrow Transplant, 24, 563, 10.1016/j.bbmt.2017.11.001 Hakki, 2015, The clinical impact of coronavirus infection in patients with hematologic malignancies and hematopoietic stem cell transplant recipients, J Clin Virol, 68, 1, 10.1016/j.jcv.2015.04.012 Pochon, 2019, Respiratory virus infections in hematopoietic cell transplant recipients, Front Microbiol, 9, 3294, 10.3389/fmicb.2018.03294 Chemaly, 2014, Management of respiratory viral infections in hematopoietic cell transplant recipients and patients with hematologic malignancies, Clin Infect Dis, 59, S344, 10.1093/cid/ciu623 Shah, 2016, Parainfluenza virus infections in hematopoietic cell transplant recipients and hematologic malignancy patients: a systematic review, Cancer Lett, 370, 358, 10.1016/j.canlet.2015.11.014 Kuderer, 2020, Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study, Lancet, 395, 1907, 10.1016/S0140-6736(20)31187-9 Robilotti, 2020, Determinants of COVID-19 disease severity in patients with cancer, Nat Med, 26, 1218, 10.1038/s41591-020-0979-0 Khawaja, 2019, Respiratory syncytial virus in hematopoietic cell transplant recipients and patients with hematologic malignancies, Haematologica, 104, 1322, 10.3324/haematol.2018.215152 Kmeid, 2016, Outcomes of influenza infections in hematopoietic cell transplant recipients: application of an immunodeficiency scoring index, Biol Blood Marrow Transplant, 22, 542, 10.1016/j.bbmt.2015.11.015 Dadwal, 2011, Comparison of clinical features and outcomes in haematopoietic cell transplant recipients infected with 2009 pandemic H1N1 influenza A and seasonal influenza A virus, Bone Marrow Transplant, 46, S26 Renaud, 2012, Antiviral therapy of respiratory viruses in haematopoietic stem cell transplant recipients, Antivir Ther, 17, 175, 10.3851/IMP2060 Ogimi, 2019, Characteristics and outcomes of coronavirus infection in children: the role of viral factors and an immunocompromised state, J Pediatric Infect Dis Soc, 8, 21, 10.1093/jpids/pix093 Westblade, 2020, SARS-CoV-2 viral load predicts mortality in patients with and without cancer who are hospitalized with COVID-19, Cancer Cell, 38, 661, 10.1016/j.ccell.2020.09.007 Benotmane, 2020, In-depth virological assessment of kidney transplant recipients with COVID-19, Am J Transplant, 20, 3162, 10.1111/ajt.16251 Pujadas, 2020, SARS-CoV-2 viral load predicts COVID-19 mortality, Lancet Respir Med, 8, e70, 10.1016/S2213-2600(20)30354-4 Wadman, 2020, Why obesity worsens COVID-19, Science, 369, 1280, 10.1126/science.369.6509.1280 Sales-Peres, 2020, Coronavirus (SARS-CoV-2) and the risk of obesity for critically illness and ICU admitted: Meta-analysis of the epidemiological evidence, Obes Res Clin Pract, 14, 389, 10.1016/j.orcp.2020.07.007 Argyropoulos, 2020, Association of initial viral load in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with outcome and symptoms, Am J Pathol, 190, 1881, 10.1016/j.ajpath.2020.07.001 Sanchez-Pina, 2020, Clinical course and risk factors for mortality from COVID-19 in patients with haematological malignancies, Eur J Haematol, 105, 597, 10.1111/ejh.13493 Seo, 2019, Risk factors for parainfluenza virus lower respiratory tract disease after hematopoietic cell transplantation, Biol Blood Marrow Transplant, 25, 163, 10.1016/j.bbmt.2018.08.021 Seo, 2017, Human rhinovirus detection in the lower respiratory tract of hematopoietic cell transplant recipients: association with mortality, Haematologica, 102, 1120, 10.3324/haematol.2016.153767 Vakil, 2018, Risk factors for mortality after respiratory syncytial virus lower respiratory tract infection in adults with hematologic malignancies, Transpl Infect Dis, 20, e12994, 10.1111/tid.12994 Choi, 2011, Differences in clinical outcomes after 2009 influenza A/H1N1 and seasonal influenza among hematopoietic cell transplant recipients, Blood, 117, 5050, 10.1182/blood-2010-11-319186 Fisher, 2018, A multicenter consortium to define the epidemiology and outcomes of inpatient respiratory viral infections in pediatric hematopoietic stem cell transplant recipients, J Pediatric Infect Dis Soc, 7, 275, 10.1093/jpids/pix051 Sim, 2018, Viral respiratory tract infections in allogeneic hematopoietic stem cell transplantation recipients in the era of molecular testing, Biol Blood Marrow Transplant, 24, 1490, 10.1016/j.bbmt.2018.03.004 Shah, 2013, Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections, J Antimicrob Chemother, 68, 1872, 10.1093/jac/dkt111