Svetlana Herasevich, MD,
Research Fellow
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Ryan Frank, MS
Senior Biostatistician
Mayo Clinic
Rochester, Minnesota, United States
Disclosure information not submitted.
William Hogan, MBBCh
Hematology Consultant
Mayo Clinic, United States
Disclosure information not submitted.
Hassan Alkhateeb, MD
Hematology Consultant
Mayo Clinic, United States
Disclosure information not submitted.
Ognjen Gajic, MD
Professor
Mayo Clinic
Rochester, Minnesota, United States
Disclosure information not submitted.
Hemang Yadav, MBBS
Pulmonary and Critical Care Consultant
Mayo Clinic, United States
Disclosure information not submitted.
Title: In-hospital Risk Factors for Acute Respiratory Distress Syndrome after Bone Marrow Transplantation
Introduction: Hematopoietic stem cell transplantation (HCT) is an advanced treatment for numerous hematologic disorders. HCT recipients are at risk for various pulmonary complications, particularly acute respiratory distress syndrome (ARDS), which occurs in 5% of patients undergoing HCT and is a major contributor to post-HCT mortality. Timely identification of patients who are at high risk of ARDS development at time of hospital admission or early in the hospital course is crucial for mechanistic investigations into the ARDS mechanism after HCT, and the implementation of ARDS prevention strategies. The aim of this study was to analyze in-hospital risk factors for developing ARDS in those patients who were hospitalized after HCT.
Methods: This was a case-control study of adult patients undergone a HCT at Mayo Clinic, Rochester in years 2005 – 2016 and hospitalized during the first year after HCT.
Results: Of 4350 HCT recipients, 170 ARDS cases were observed. Cases were matched to controls 1:1 on age, type of transplant (autologous vs allogeneic), and time (from HCT to ARDS onset in cases and time to hospitalization in controls). After a priori adjustment for known ARDS risk factors, cases had higher rate of oral steroid use prior to hospitalization (OR 1.90 [1.13, 3.19], p=0.02), lower platelets (OR 0.95 [0.91, 0.99], p=0.02) and bicarbonate (OR 0.94 [0.88, 0.99], p=0.03), and higher creatinine (OR 1.91 [1.23, 2.94], p=0.004) at time of hospital admission. Cases were more likely to have higher max temperature (OR 1.75 [1.32, 2.32]), respiratory rate (OR 1.52 [1.33, 1.74]), and FiO2 (OR 1.07 [1.05, 1.10]), and lower SPO2 (OR 2.96 [1.70, 5.13]). Cases were more likely to have hypoglycemia (OR 6.28 [1.25, 31.40], p=0.03), sepsis (OR 67.99 [15.32, 301.70], p< 0.001), bloodstream and respiratory infection, and have received transfusion, narcotic medications, or infusion therapy in hospital before ARDS onset. Cases were less likely to have disease relapse and to have been hospitalized for symptom control compared to controls.
Conclusions: Several in-hospital variables help identify patients at increased risk of post-transplant ARDS. Being able to identify those at highest risk of ARDS can help enrich clinical trials designed to test potential targeted interventions and ARDS prevention strategies in HCT population.