Significant Transplant-Related Mortality from Respiratory Virus Infections within the First 100 Days Post Hematopoietic Stem Cell Transplantation
Bibliographic record
Abstract
Respiratory virus infections are recognized as an important complication in hematopoietic stem cell transplantation (HSCT). Respiratory syncytial virus (RSV), influenza, and parainfluenza have been associated with high morbidity and mortality post HSCT. Despite an increasing number of reports, knowledge regarding risk factors and long term pulmonary complications are still very limited. Therefore, we report our study to evaluate incidence and outcome of respiratory virus infections following HSCT in a large pediatric transplant centre. Eight hundred and forty four children received HSCT during the study period (January 2000 and August 2012). The number of patients undergoing allogeneic (allo) transplant was 489 and autologous (auto) was 355. Thirty-five patients (4.2%) were found to have respiratory virus infection diagnosed by a nasopharyngeal aspirate (NPA) in the first 100 days post HSCT. Among these, 22 (63%) and 13 (37%) were allo and auto HSCT recipients, respectively. Upper and lower respiratory tract infection were documented in 19 (54.3%) and 16 (45.7%) patients, respectively. The viruses identified were parainfluenza 37%, influenza 26%, RSV 23%, adenovirus 11%, and human metapneumovirus 3%. None of the patients had significant respiratory symptoms prior to HSCT. Seven patients died from disease relapse and were excluded from outcome analysis. Of the remaining 28 patients, five HSCT recipients (4 allo and 1 auto) have died (18%). All patients who died were in the lower respiratory tract infection group and their death was directly attributed to pulmonary complications as a result of respiratory virus infections. Two patients died from adenovirus pneumonitis and ARDS. Two patients died from severe parainfluenza infection with deterioration of symptoms and respiratory failure despite treatment with ribavarin and the last patient had ARDS from RSV infection. No chronic pulmonary complication or allo-immune lung syndrome was observed among the remaining 23 survivors with a median follow-up time of 3.8 years (8 months-10.3 years). This study supports the significant TRM from respiratory virus infection diagnosed within the first 100 days post HSCT particularly in patients presented with lower respiratory tract infection. Higher mortality was observed among allo recipients. Every effort should be made to prevent respiratory virus infections early post HSCT.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".