This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
BACKGROUND: ARDS is a serious complication of hematopoietic stem cell transplant (HSCT). Pre-transplant risk factors for developing ARDS after HSCT have been recently identified. The objective of this study was to better understand post-transplant risk factors for developing ARDS after HSCT.
METHODS: This was a nested case-control study. ARDS cases were matched to hospitalized non-ARDS controls by age, type of transplantation (allogeneic vs autologous), and time from transplantation. In a conditional logistic regression model, any potential risk factors were adjusted a priori for risk factors known to be associated with ARDS development.
RESULTS: One hundred and seventy ARDS cases were matched 1:1 to non-ARDS hospitalized controls. Pre-admission, cases were more likely to be on steroids (odds ratio [OR] 1.90 [1.13–3.19], P = .02). At time of admission, cases had lower platelet count (OR 0.95 [0.91–0.99], P = .02), lower bicarbonate (OR 0.94 [0.88–0.99], P = .035), and higher creatinine (OR 1.91 [1.23–2.94], P = .004). During the first 24 h after admission, cases were more likely to have received transfusion (OR 2.41 [1.48–3.94], P < .001), opioids (OR 2.94 [1.67–5.18], P < .001), and have greater fluid administration (OR 1.52 [1.30–1.78], P < .001). During the hospitalization, ARDS cases had higher temperature (OR 1.77 [1.34–2.33], P < .001) and higher breathing frequency (OR 1.52 [1.33–1.74], P < .001). ARDS cases were more likely to have had sepsis (OR 68.0 [15.2–301.7], P < .001), bloodstream infection (OR 4.59 [2.46–8.57], P < .001), and pneumonia (OR 9.76 [5.01–19.00], P < .001).
CONCLUSIONS: Several post-transplant predictors of ARDS development specific to the HSCT population were identified in the pre-hospital and early in-hospital domains. These findings can provide insights into causal mechanisms of ARDS development and be used to develop HSCT-specific risk prediction models.
- ARDS
- bone marrow transplant
- hematopoietic stem cell transplantation
- respiratory failure
- ICU
- immunocompromised host
Footnotes
- Correspondence: Hemang Yadav MBBS, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905. E-mail: yadav.hemang{at}mayo.edu
The authors have disclosed no conflicts of interest.
Dr Herasevich presented a version of this paper at the Society of Critical Care Medicine, held virtually April 18–21, 2022.
This research was supported by the National Heart, Lung, and Blood Institute grant number K23HL151671 and the Mayo Clinic Transplant Center Research Committee Scholar Award (recipient: Dr Yadav).
Supplementary material related to this paper is available at http://www.rcjournal.com.
- Copyright © 2023 by Daedalus Enterprises
Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.