Table 4.
Risk factors for mortality from all causes or respiratory failure by day 100 after RSV LRD in patients transplanted between 1997 and 2010 (n=58)
| Overall mortality | Mortality from respiratory failure | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Risk factors | Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | ||||||||
| HR | 95% CI | P Value | HR | 95% CI | P Value | HR | 95% CI | P Value | HR | 95% CI | P Value | |
| Transplant year | ||||||||||||
| 1997-2001 | 1.00 | 1.00 | ||||||||||
| 2002-2010 | 0.95 | 0.4-2.2 | 0.907 | 0.81 | 0.3-2.2 | 0.686 | ||||||
| Stem cell source | ||||||||||||
| Peripheral blood stem cell | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||
| Bone marrow | 3.77 | 1.5-9.4 | 0.004 | 4.71 | 1.9-12 | 0.001 | 5.16 | 1.6-16 | 0.005 | 7.76 | 2.4-25 | <.001 |
| Cord blood | 1.06 | 0.1-8.6 | 0.956 | 1.85 | 0.2-17 | 0.581 | ||||||
| Conditioning regimen | ||||||||||||
| MA + TBI (> 12Gy) | 1.00 | 1.00 | ||||||||||
| MA ± low TBI | 0.83 | 0.3-2.3 | 0.725 | 0.20 | 0.0-1.5 | 0.118 | ||||||
| Reduced intensity conditioning | 0.78 | 0.3-2.4 | 0.670 | 0.91 | 0.3-2.9 | 0.867 | ||||||
| White blood cell counts | ||||||||||||
| > 1000 ×106/L | 1.00 | 1.00 | ||||||||||
| ≤ 1000 ×106/L | 1.86 | 0.8-4.3 | 0.147 | 1.76 | 0.7-4.7 | 0.262 | ||||||
| Co-pathogen | ||||||||||||
| None | 1.00 | 1.00 | ||||||||||
| Any pathogen | 1.10 | 0.4-2.9 | 0.843 | 0.71 | 0.2-2.6 | 0.601 | ||||||
| Multiple pathogens | 2.22 | 0.6-7.8 | 0.214 | 2.81 | 0.8-10 | 0.118 | ||||||
| Oxygen at diagnosis* | ||||||||||||
| None | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||
| ≤ 2L/minute | 0.51 | 0.1-4.2 | 0.532 | 1.19 | 0.1-12 | 0.878 | ||||||
| > 2L/minute | 3.24 | 1.2-8.8 | 0.020 | 3.57 | 1.4-9.0 | 0.007 | 6.57 | 1.7-25 | 0.006 | 7.98 | 2.2-29 | 0.001 |
| Mechanical ventilation | 3.58 | 0.9-14 | 0.065 | 5.59 | 0.9-34 | 0.060 | ||||||
| Steroid use at diagnosis | ||||||||||||
| None | 1.00 | 1.00 | ||||||||||
| < 1 mg/kg | 0.80 | 0.3-2.1 | 0.645 | 0.94 | 0.3-3.1 | 0.913 | ||||||
| ≥ 1 mg/kg | 2.00 | 0.7-5.9 | 0.208 | 3.19 | 1.0-11 | 0.057 | ||||||
| Ribavirin use pre diagnosis | ||||||||||||
| None | 1.00 | |||||||||||
| < 5 days | 0.37 | 0.1-2.8 | 0.338 | |||||||||
| ≥ 5 days | 0.25 | 0.0-1.9 | 0.180 | |||||||||
| Ab-based treatment as time-dependent | ||||||||||||
| None/Low-dose | 1.00 | 1.00 | ||||||||||
| High-dose | 1.49 | 0.4-6.0 | 0.575 | 1.19 | 0.3-5.3 | 0.824 | ||||||
| Palivizumab** | 1.11 | 0.4-3.4 | 0.856 | 0.77 | 0.2-2.5 | 0.671 | ||||||
All variables in Table 1 were used for the univariate analysis. Only variables with p < 0.2 in any analysis are shown in this table. The following parameters were not significantly associated; gender, age at RSV LRD, days between transplant and RSV LRD, donor type, diagnosis, disease risk at transplantation, GVHD prophylaxis, recipient CMV serostatus, and GVHD in lung at RSV LRD, %FEV1/FVC pre RSV LRD, %TLC pre RSV LRD, lymphocyte count. The factors with p < 0.1 were evaluated in the multivariable models.
In the multivariate analysis, oxgen at diagnosis were categorized into two groups; none + ≤ 2L/minute and > 2L/minute + mechanical ventilation.
This includes two patients who received both palivizumab and high-dose intravenous immunoglobulin.
Abbreviations; MA: myeloablative conditioning, TBI: total body irradiation, FEV1: foeced expiratory volume in 1 second, FVC: forced vital capacity %TLC: percentage of predicted total lung capacity, GVHD: graft versus host disease, CMV: cytomegalovirus