Corticosteroid use as adjunct therapy for respiratory syncytial virus infection in adult allogeneic stem cell transplant recipients.

BACKGROUND: Respiratory syncytial virus (RSV) infection causes significant morbidity and mortality in allogeneic stem cell transplant (allo-SCT) recipients. Although ribavirin and immunoglobulins are common components of therapy, the role of adjunct corticosteroids is not established. OBJECTIVES: We sought to evaluate corticosteroid utilization in the setting of post-allo-SCT RSV infection in our center and assess post-transplant outcomes including pulmonary function decline. METHODS: Patients with a history of RSV infection from 2008 to 2014 seen at our institution were identified. Treatment and outcome data were retrospectively collected. Forced expiratory volume at 1 s (FEV1) and carbon monoxide diffusion capacity (DLCO) were collected pre- and post-RSV infection. RESULTS: During the observation period, RSV was isolated in 53 of 552 patients undergoing allo-SCT (10%) and 45 had evaluable therapy data. RSV-related mortality in this cohort was 4/45 (9%). Twenty-one (47%) were on corticosteroids prior to RSV diagnosis, of whom 11 (24%) had a dose increase post symptom onset. Eight (18%) patients were started on corticosteroids at the time of RSV infection. Corticosteroid therapy at symptom onset was associated with a higher rate of upper respiratory infection (URTI) to lower respiratory infection (LRTI) progression risk ratio (RR) 2.49 (1.21-5.13; P = 0.016), hospital admission RR 2.05 (1.24-3.37; P = 0.005), or intensive care unit admission RR 2.91 (1.89-5.01; P = 0.002). No significant difference was seen with FEV1 and DLCO decline (P = 0.3 and 0.24, respectively) or mortality (P = 0.26). CONCLUSION: Adjunct corticosteroid use in the setting of RSV infection did not improve RSV-related outcomes including long-term pulmonary function. Our results do not support the routine use of corticosteroids; however, this finding does need to be verified in a larger cohort of patients.

Acute lung injury prediction score: derivation and validation in a population-based sample.

Early recognition of patients at high risk of acute lung injury (ALI) is critical for successful enrollment of patients in prevention strategies for this devastating syndrome. We aimed to develop and prospectively validate an ALI prediction score in a population-based sample of patients at risk. In a retrospective derivation cohort, predisposing conditions for ALI were identified at the time of hospital admission. The score was calculated based on the results of logistic regression analysis. Prospective validation was performed in an independent cohort of patients at risk identified at the time of hospital admission. In a derivation cohort of 409 patients with ALI risk factors, the lung injury prediction score discriminated patients who developed ALI from those who did not with an area under the curve (AUC) of 0.84 (95% CI 0.80-0.89; Hosmer-Lemeshow p = 0.60). The performance was similar in a prospective validation cohort of 463 patients at risk of ALI (AUC 0.84, 95% CI 0.77-0.91; Hosmer-Lemeshow p = 0.88). ALI prediction scores identify patients at high risk for ALI before intensive care unit admission. If externally validated, this model will serve to define the population of patients at high risk for ALI in whom future mechanistic studies and ALI prevention trials will be conducted.