Baseline Characteristics and Clinical Outcomes of Patients With Hematologic Malignancy and Respiratory Viral Infection, by Site of Infection
| Variablea . | Total (N = 490) . | LRI (n = 206) . | URI (n = 284) . | P Value . |
|---|---|---|---|---|
| Demographics | ||||
| Age at RVI diagnosis, y, mean ± SD | 61.8 ± 13.8 | 63.9 ± 13.2 | 60.2 ± 14.0 | .003 |
| Sex | ||||
| Female | 216 (44.1) | 90 (43.7) | 126 (44.4) | .882 |
| Male | 274 (55.9) | 116 (56.3) | 158 (55.6) | |
| Race/ethnicity | ||||
| Non-Hispanic White | 277 (56.5) | 116 (56.3) | 161 (56.6) | .840 |
| Hispanic | 88 (18.0) | 39 (18.9) | 49 (17.3) | |
| Black | 92 (18.8) | 40 (19.4) | 52 (18.3) | |
| Asian | 29 (5.9) | 10 (4.9) | 19 (6.7) | |
| Other | 4 (0.8) | 1 (0.5) | 3 (1.1) | |
| Smoking statusb | ||||
| Never | 314 (64.2) | 119 (58.1) | 195 (68.7) | .048 |
| Former | 161 (32.9) | 80 (39.0) | 81 (28.5) | |
| Current | 14 (2.9) | 6 (2.9) | 8 (2.8) | |
| Influenza vaccination (current season) | 130 (26.5) | 51 (24.8) | 79 (27.8) | .449 |
| HM characteristics | ||||
| HM diagnosis | ||||
| Hodgkin lymphoma | 31 (6.3) | 11 (5.3) | 20 (7.0) | .163 |
| Non-Hodgkin lymphoma | 162 (33.1) | 60 (29.1) | 102 (35.9) | |
| Multiple myeloma | 297 (60.6) | 135 (65.6) | 162 (57.1) | |
| Active malignancy at RVI diagnosis | 351 (71.6) | 167 (81.1) | 184 (64.8) | <.001 |
| Active antineoplastic treatment at RVI diagnosis | 385 (78.6) | 174 (84.5) | 211 (74.3) | .007 |
| Steroid use within 30 d of RVI diagnosis (mg prednisone equivalent) | ||||
| Any | 296 (60.4) | 151 (73.3) | 145 (51.1) | <.001 |
| 30-d cumulative steroid dosage, median (IQR)c | 533 (240–1066) | 533 (266–997) | 533 (172–1066) | .597 |
| Peak dose of ≤1 mg/kg/dd | 86 (29.2) | 43 (28.5) | 43 (29.9) | .794 |
| Peak dose of >1 mg/kg/dd | 209 (70.8) | 108 (71.5) | 101 (70.1) | |
| Previous chest radiotherapy | 96 (19.6) | 47 (22.8) | 49 (17.3) | .126 |
| History of HCT | ||||
| None | 266 (54.3) | 107 (51.9) | 159 (56.0) | .395 |
| Autologous | 214 (43.7) | 93 (45.2) | 121 (42.6) | |
| Allogeneic | 10 (2.0) | 6 (2.9) | 4 (1.4) | |
| History of CAR-T therapy | 36 (7.3) | 11 (5.3) | 25 (8.8) | .147 |
| RVI clinical course | ||||
| Pathogen | .006 | |||
| RSV | 232 (47.3) | 112 (54.4) | 120 (42.3) | |
| Influenza | 256 (52.3) | 92 (44.6) | 164 (57.7) | |
| RSV + influenza | 2 (0.4) | 2 (1.0) | 0 (0.0) | |
| Respiratory viral coinfections (during ±2 wk)e | 85 (17.3) | 40 (19.4) | 45 (15.8) | .303 |
| Year of infection | ||||
| 2016 | 45 (9.2) | 27 (13.1) | 18 (6.3) | .132 |
| 2017 | 98 (20.0) | 35 (17.0) | 63 (22.3) | |
| 2018 | 73 (14.9) | 34 (16.5) | 39 (13.7) | |
| 2019 | 115 (23.5) | 47 (22.8) | 68 (23.9) | |
| 2020 | 53 (10.8) | 19 (9.2) | 34 (12.0) | |
| 2021 | 36 (7.3) | 17 (8.3) | 19 (6.7) | |
| 2022 | 70 (14.3) | 27 (13.1) | 43 (15.1) | |
| Time period of infection | ||||
| Pre-COVID-19 era (Jan 2016–Feb 2020) | 376 (76.7) | 158 (76.7) | 218 (76.8) | .987 |
| COVID-19 era (Mar 2020–Dec 2022) | 114 (23.3) | 48 (23.3) | 66 (23.2) | |
| LRI typec | ||||
| Probable | … | 170 (82.5) | … | |
| Laboratory confirmed | … | 36 (17.5) | … | |
| RVI symptoms | ||||
| Cough | 428 (87.3) | 184 (89.3) | 244 (85.9) | .263 |
| Fever | 250 (51.0) | 116 (56.3) | 134 (47.2) | .046 |
| Shortness of breath | 162 (33.1) | 95 (46.1) | 67 (23.6) | <.001 |
| Rhinorrhea | 148 (30.2) | 40 (19.4) | 108 (38.0) | <.001 |
| Nasal congestion | 151 (30.8) | 51 (24.8) | 100 (35.2) | .013 |
| Fatigue | 149 (30.4) | 69 (33.5) | 80 (28.2) | .206 |
| Sore throat | 73 (14.9) | 26 (12.6) | 47 (16.5) | .228 |
| Chills | 81 (16.5) | 37 (18.0) | 44 (15.5) | .468 |
| Headache | 54 (11.0) | 20 (9.7) | 34 (12.0) | .430 |
| Nausea/vomiting | 55 (11.2) | 25 (12.1) | 30 (10.6) | .586 |
| Myalgia | 46 (9.4) | 16 (7.8) | 30 (10.6) | .295 |
| Diarrhea | 38 (7.8) | 19 (9.2) | 19 (6.7) | .301 |
| Chest pain | 33 (6.7) | 18 (8.7) | 15 (5.3) | .132 |
| Arthralgia | 14 (2.9) | 4 (1.9) | 10 (3.5) | .300 |
| Hypoxia at presentation (≤92%) in room airf | 49 (10.6) | 43 (21.1)g | 6 (2.3)h | <.001 |
| Nosocomial infection | 20 (4.1) | 12 (5.8) | 8 (2.8) | .097 |
| Bronchoscopy | 42 (8.6) | 41 (19.9) | 1 (0.4) | <.001 |
| Lymphopenia (<200 cells/mL) | 60 (12.2) | 44 (21.4) | 16 (5.6) | <.001 |
| Neutropenia (<500 cells/mL) | 28 (5.7) | 19 (9.2) | 9 (3.2) | .004 |
| Lymphopenia and neutropenia | 17 (3.5) | 14 (6.8) | 3 (1.1) | .001 |
| Elevated creatinine (≥1.2 mg/dL) | 146 (29.8) | 80 (38.8) | 66 (23.2) | <.001 |
| Antiviral therapy | ||||
| Any therapy | 390 (79.6) | 184 (89.3) | 206 (72.5) | <.001 |
| Ribavirin | 142 (29.0) | 92 (44.7) | 50 (17.6) | <.001 |
| Oseltamiviri | 245 (50.0) | 91 (44.2) | 154 (54.2) | .028 |
| IVIG | 67 (13.7) | 54 (26.2) | 13 (4.6) | <.001 |
| Antiviral timing from symptom onset | ||||
| No treatment | 100 (20.4) | 22 (10.7) | 78 (27.5) | <.001 |
| Within 48 h | 139 (28.4) | 56 (27.2) | 83 (29.2) | |
| After 48 h | 251 (51.2) | 128 (62.1) | 123 (43.3) | |
| RVI outcomes | ||||
| Hospital admission | ||||
| Any | 280 (57.1) | 180 (87.4) | 100 (35.2) | <.001 |
| Secondary to RVI | 232 (47.3) | 154 (74.8) | 78 (27.5) | <.001 |
| Length of stay, d, median (IQR)j | 5 (3–9) | 7 (4–12) | 3 (2–5) | <.001 |
| ICU admission | 38 (7.8) | 36 (17.5) | 2 (0.7) | <.001 |
| Oxygen requirement (maximal) | ||||
| None | 332 (67.8) | 74 (35.8) | 258 (90.8) | <.001 |
| Nasal cannula | 98 (20.0) | 72 (35.0) | 26 (9.2) | |
| Face mask | 8 (1.6) | 8 (3.9) | 0 (0.0) | |
| HFNC | 20 (4.1) | 20 (9.7) | 0 (0.0) | |
| BiPAP | 15 (3.1) | 15 (7.3) | 0 (0.0) | |
| Mechanical ventilation | 17 (3.5) | 17 (8.3) | 0 (0.0) | |
| Follow-up duration, d, median (IQR) | 90 (90–90) | 90 (90–90) | 90 (90–90) | <.001 |
| 30-d all-cause mortality | 20 (4.1) | 20 (9.7) | 0 (0.0) | <.001 |
| 30-d RVI-related mortality | 19 (3.9) | 19 (9.2) | 0 (0.0) | <.001 |
| 90-d all-cause mortality | 32 (6.5) | 27 (13.1) | 5 (1.8) | <.001 |
| Variablea . | Total (N = 490) . | LRI (n = 206) . | URI (n = 284) . | P Value . |
|---|---|---|---|---|
| Demographics | ||||
| Age at RVI diagnosis, y, mean ± SD | 61.8 ± 13.8 | 63.9 ± 13.2 | 60.2 ± 14.0 | .003 |
| Sex | ||||
| Female | 216 (44.1) | 90 (43.7) | 126 (44.4) | .882 |
| Male | 274 (55.9) | 116 (56.3) | 158 (55.6) | |
| Race/ethnicity | ||||
| Non-Hispanic White | 277 (56.5) | 116 (56.3) | 161 (56.6) | .840 |
| Hispanic | 88 (18.0) | 39 (18.9) | 49 (17.3) | |
| Black | 92 (18.8) | 40 (19.4) | 52 (18.3) | |
| Asian | 29 (5.9) | 10 (4.9) | 19 (6.7) | |
| Other | 4 (0.8) | 1 (0.5) | 3 (1.1) | |
| Smoking statusb | ||||
| Never | 314 (64.2) | 119 (58.1) | 195 (68.7) | .048 |
| Former | 161 (32.9) | 80 (39.0) | 81 (28.5) | |
| Current | 14 (2.9) | 6 (2.9) | 8 (2.8) | |
| Influenza vaccination (current season) | 130 (26.5) | 51 (24.8) | 79 (27.8) | .449 |
| HM characteristics | ||||
| HM diagnosis | ||||
| Hodgkin lymphoma | 31 (6.3) | 11 (5.3) | 20 (7.0) | .163 |
| Non-Hodgkin lymphoma | 162 (33.1) | 60 (29.1) | 102 (35.9) | |
| Multiple myeloma | 297 (60.6) | 135 (65.6) | 162 (57.1) | |
| Active malignancy at RVI diagnosis | 351 (71.6) | 167 (81.1) | 184 (64.8) | <.001 |
| Active antineoplastic treatment at RVI diagnosis | 385 (78.6) | 174 (84.5) | 211 (74.3) | .007 |
| Steroid use within 30 d of RVI diagnosis (mg prednisone equivalent) | ||||
| Any | 296 (60.4) | 151 (73.3) | 145 (51.1) | <.001 |
| 30-d cumulative steroid dosage, median (IQR)c | 533 (240–1066) | 533 (266–997) | 533 (172–1066) | .597 |
| Peak dose of ≤1 mg/kg/dd | 86 (29.2) | 43 (28.5) | 43 (29.9) | .794 |
| Peak dose of >1 mg/kg/dd | 209 (70.8) | 108 (71.5) | 101 (70.1) | |
| Previous chest radiotherapy | 96 (19.6) | 47 (22.8) | 49 (17.3) | .126 |
| History of HCT | ||||
| None | 266 (54.3) | 107 (51.9) | 159 (56.0) | .395 |
| Autologous | 214 (43.7) | 93 (45.2) | 121 (42.6) | |
| Allogeneic | 10 (2.0) | 6 (2.9) | 4 (1.4) | |
| History of CAR-T therapy | 36 (7.3) | 11 (5.3) | 25 (8.8) | .147 |
| RVI clinical course | ||||
| Pathogen | .006 | |||
| RSV | 232 (47.3) | 112 (54.4) | 120 (42.3) | |
| Influenza | 256 (52.3) | 92 (44.6) | 164 (57.7) | |
| RSV + influenza | 2 (0.4) | 2 (1.0) | 0 (0.0) | |
| Respiratory viral coinfections (during ±2 wk)e | 85 (17.3) | 40 (19.4) | 45 (15.8) | .303 |
| Year of infection | ||||
| 2016 | 45 (9.2) | 27 (13.1) | 18 (6.3) | .132 |
| 2017 | 98 (20.0) | 35 (17.0) | 63 (22.3) | |
| 2018 | 73 (14.9) | 34 (16.5) | 39 (13.7) | |
| 2019 | 115 (23.5) | 47 (22.8) | 68 (23.9) | |
| 2020 | 53 (10.8) | 19 (9.2) | 34 (12.0) | |
| 2021 | 36 (7.3) | 17 (8.3) | 19 (6.7) | |
| 2022 | 70 (14.3) | 27 (13.1) | 43 (15.1) | |
| Time period of infection | ||||
| Pre-COVID-19 era (Jan 2016–Feb 2020) | 376 (76.7) | 158 (76.7) | 218 (76.8) | .987 |
| COVID-19 era (Mar 2020–Dec 2022) | 114 (23.3) | 48 (23.3) | 66 (23.2) | |
| LRI typec | ||||
| Probable | … | 170 (82.5) | … | |
| Laboratory confirmed | … | 36 (17.5) | … | |
| RVI symptoms | ||||
| Cough | 428 (87.3) | 184 (89.3) | 244 (85.9) | .263 |
| Fever | 250 (51.0) | 116 (56.3) | 134 (47.2) | .046 |
| Shortness of breath | 162 (33.1) | 95 (46.1) | 67 (23.6) | <.001 |
| Rhinorrhea | 148 (30.2) | 40 (19.4) | 108 (38.0) | <.001 |
| Nasal congestion | 151 (30.8) | 51 (24.8) | 100 (35.2) | .013 |
| Fatigue | 149 (30.4) | 69 (33.5) | 80 (28.2) | .206 |
| Sore throat | 73 (14.9) | 26 (12.6) | 47 (16.5) | .228 |
| Chills | 81 (16.5) | 37 (18.0) | 44 (15.5) | .468 |
| Headache | 54 (11.0) | 20 (9.7) | 34 (12.0) | .430 |
| Nausea/vomiting | 55 (11.2) | 25 (12.1) | 30 (10.6) | .586 |
| Myalgia | 46 (9.4) | 16 (7.8) | 30 (10.6) | .295 |
| Diarrhea | 38 (7.8) | 19 (9.2) | 19 (6.7) | .301 |
| Chest pain | 33 (6.7) | 18 (8.7) | 15 (5.3) | .132 |
| Arthralgia | 14 (2.9) | 4 (1.9) | 10 (3.5) | .300 |
| Hypoxia at presentation (≤92%) in room airf | 49 (10.6) | 43 (21.1)g | 6 (2.3)h | <.001 |
| Nosocomial infection | 20 (4.1) | 12 (5.8) | 8 (2.8) | .097 |
| Bronchoscopy | 42 (8.6) | 41 (19.9) | 1 (0.4) | <.001 |
| Lymphopenia (<200 cells/mL) | 60 (12.2) | 44 (21.4) | 16 (5.6) | <.001 |
| Neutropenia (<500 cells/mL) | 28 (5.7) | 19 (9.2) | 9 (3.2) | .004 |
| Lymphopenia and neutropenia | 17 (3.5) | 14 (6.8) | 3 (1.1) | .001 |
| Elevated creatinine (≥1.2 mg/dL) | 146 (29.8) | 80 (38.8) | 66 (23.2) | <.001 |
| Antiviral therapy | ||||
| Any therapy | 390 (79.6) | 184 (89.3) | 206 (72.5) | <.001 |
| Ribavirin | 142 (29.0) | 92 (44.7) | 50 (17.6) | <.001 |
| Oseltamiviri | 245 (50.0) | 91 (44.2) | 154 (54.2) | .028 |
| IVIG | 67 (13.7) | 54 (26.2) | 13 (4.6) | <.001 |
| Antiviral timing from symptom onset | ||||
| No treatment | 100 (20.4) | 22 (10.7) | 78 (27.5) | <.001 |
| Within 48 h | 139 (28.4) | 56 (27.2) | 83 (29.2) | |
| After 48 h | 251 (51.2) | 128 (62.1) | 123 (43.3) | |
| RVI outcomes | ||||
| Hospital admission | ||||
| Any | 280 (57.1) | 180 (87.4) | 100 (35.2) | <.001 |
| Secondary to RVI | 232 (47.3) | 154 (74.8) | 78 (27.5) | <.001 |
| Length of stay, d, median (IQR)j | 5 (3–9) | 7 (4–12) | 3 (2–5) | <.001 |
| ICU admission | 38 (7.8) | 36 (17.5) | 2 (0.7) | <.001 |
| Oxygen requirement (maximal) | ||||
| None | 332 (67.8) | 74 (35.8) | 258 (90.8) | <.001 |
| Nasal cannula | 98 (20.0) | 72 (35.0) | 26 (9.2) | |
| Face mask | 8 (1.6) | 8 (3.9) | 0 (0.0) | |
| HFNC | 20 (4.1) | 20 (9.7) | 0 (0.0) | |
| BiPAP | 15 (3.1) | 15 (7.3) | 0 (0.0) | |
| Mechanical ventilation | 17 (3.5) | 17 (8.3) | 0 (0.0) | |
| Follow-up duration, d, median (IQR) | 90 (90–90) | 90 (90–90) | 90 (90–90) | <.001 |
| 30-d all-cause mortality | 20 (4.1) | 20 (9.7) | 0 (0.0) | <.001 |
| 30-d RVI-related mortality | 19 (3.9) | 19 (9.2) | 0 (0.0) | <.001 |
| 90-d all-cause mortality | 32 (6.5) | 27 (13.1) | 5 (1.8) | <.001 |
The difference in follow-up duration is more clearly illustrated when presented as the mean ± SD rather than the median and IQR. In the URI group, the mean duration was 85.4 ± 18.5 years, compared to 78.2 ± 26.5 years in the LRI group. P values less than .05 are indicated in bold format.
Abbreviations: BiPAP, bilevel positive airway pressure; CAR-T, chimeric antigen receptor T-cell; COVID-19, coronavirus disease 2019; HCT, hematopoietic stem cell transplantation; HFNC, high-flow nasal cannula; HM, hematologic malignancy; ICU, intensive care unit; IQR, interquartile range; IVIG, intravenous immunoglobulin; LRI, lower respiratory tract infection; RSV, respiratory syncytial virus; RVI, respiratory virus infection; SD, standard deviation; URI, upper respiratory tract infection.
aData are presented as No. (%) unless otherwise specified.
bn = 489.
cn = 294.
dn = 295.
eViral coinfections included rhinovirus (n = 34), seasonal human coronavirus (non–severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) (n = 31), SARS-CoV-2 (n = 4), parainfluenza (n = 10), human metapneumovirus (n = 7), adenovirus (n = 1), and cytomegalovirus pneumonitis (n = 3).
fn = 462.
gn = 204.
hn = 258.
iThree RSV-infected patients were treated empirically with oseltamivir before the respiratory virus panel results were received.
jn = 280.
Baseline Characteristics and Clinical Outcomes of Patients With Hematologic Malignancy and Respiratory Viral Infection, by Site of Infection
| Variablea . | Total (N = 490) . | LRI (n = 206) . | URI (n = 284) . | P Value . |
|---|---|---|---|---|
| Demographics | ||||
| Age at RVI diagnosis, y, mean ± SD | 61.8 ± 13.8 | 63.9 ± 13.2 | 60.2 ± 14.0 | .003 |
| Sex | ||||
| Female | 216 (44.1) | 90 (43.7) | 126 (44.4) | .882 |
| Male | 274 (55.9) | 116 (56.3) | 158 (55.6) | |
| Race/ethnicity | ||||
| Non-Hispanic White | 277 (56.5) | 116 (56.3) | 161 (56.6) | .840 |
| Hispanic | 88 (18.0) | 39 (18.9) | 49 (17.3) | |
| Black | 92 (18.8) | 40 (19.4) | 52 (18.3) | |
| Asian | 29 (5.9) | 10 (4.9) | 19 (6.7) | |
| Other | 4 (0.8) | 1 (0.5) | 3 (1.1) | |
| Smoking statusb | ||||
| Never | 314 (64.2) | 119 (58.1) | 195 (68.7) | .048 |
| Former | 161 (32.9) | 80 (39.0) | 81 (28.5) | |
| Current | 14 (2.9) | 6 (2.9) | 8 (2.8) | |
| Influenza vaccination (current season) | 130 (26.5) | 51 (24.8) | 79 (27.8) | .449 |
| HM characteristics | ||||
| HM diagnosis | ||||
| Hodgkin lymphoma | 31 (6.3) | 11 (5.3) | 20 (7.0) | .163 |
| Non-Hodgkin lymphoma | 162 (33.1) | 60 (29.1) | 102 (35.9) | |
| Multiple myeloma | 297 (60.6) | 135 (65.6) | 162 (57.1) | |
| Active malignancy at RVI diagnosis | 351 (71.6) | 167 (81.1) | 184 (64.8) | <.001 |
| Active antineoplastic treatment at RVI diagnosis | 385 (78.6) | 174 (84.5) | 211 (74.3) | .007 |
| Steroid use within 30 d of RVI diagnosis (mg prednisone equivalent) | ||||
| Any | 296 (60.4) | 151 (73.3) | 145 (51.1) | <.001 |
| 30-d cumulative steroid dosage, median (IQR)c | 533 (240–1066) | 533 (266–997) | 533 (172–1066) | .597 |
| Peak dose of ≤1 mg/kg/dd | 86 (29.2) | 43 (28.5) | 43 (29.9) | .794 |
| Peak dose of >1 mg/kg/dd | 209 (70.8) | 108 (71.5) | 101 (70.1) | |
| Previous chest radiotherapy | 96 (19.6) | 47 (22.8) | 49 (17.3) | .126 |
| History of HCT | ||||
| None | 266 (54.3) | 107 (51.9) | 159 (56.0) | .395 |
| Autologous | 214 (43.7) | 93 (45.2) | 121 (42.6) | |
| Allogeneic | 10 (2.0) | 6 (2.9) | 4 (1.4) | |
| History of CAR-T therapy | 36 (7.3) | 11 (5.3) | 25 (8.8) | .147 |
| RVI clinical course | ||||
| Pathogen | .006 | |||
| RSV | 232 (47.3) | 112 (54.4) | 120 (42.3) | |
| Influenza | 256 (52.3) | 92 (44.6) | 164 (57.7) | |
| RSV + influenza | 2 (0.4) | 2 (1.0) | 0 (0.0) | |
| Respiratory viral coinfections (during ±2 wk)e | 85 (17.3) | 40 (19.4) | 45 (15.8) | .303 |
| Year of infection | ||||
| 2016 | 45 (9.2) | 27 (13.1) | 18 (6.3) | .132 |
| 2017 | 98 (20.0) | 35 (17.0) | 63 (22.3) | |
| 2018 | 73 (14.9) | 34 (16.5) | 39 (13.7) | |
| 2019 | 115 (23.5) | 47 (22.8) | 68 (23.9) | |
| 2020 | 53 (10.8) | 19 (9.2) | 34 (12.0) | |
| 2021 | 36 (7.3) | 17 (8.3) | 19 (6.7) | |
| 2022 | 70 (14.3) | 27 (13.1) | 43 (15.1) | |
| Time period of infection | ||||
| Pre-COVID-19 era (Jan 2016–Feb 2020) | 376 (76.7) | 158 (76.7) | 218 (76.8) | .987 |
| COVID-19 era (Mar 2020–Dec 2022) | 114 (23.3) | 48 (23.3) | 66 (23.2) | |
| LRI typec | ||||
| Probable | … | 170 (82.5) | … | |
| Laboratory confirmed | … | 36 (17.5) | … | |
| RVI symptoms | ||||
| Cough | 428 (87.3) | 184 (89.3) | 244 (85.9) | .263 |
| Fever | 250 (51.0) | 116 (56.3) | 134 (47.2) | .046 |
| Shortness of breath | 162 (33.1) | 95 (46.1) | 67 (23.6) | <.001 |
| Rhinorrhea | 148 (30.2) | 40 (19.4) | 108 (38.0) | <.001 |
| Nasal congestion | 151 (30.8) | 51 (24.8) | 100 (35.2) | .013 |
| Fatigue | 149 (30.4) | 69 (33.5) | 80 (28.2) | .206 |
| Sore throat | 73 (14.9) | 26 (12.6) | 47 (16.5) | .228 |
| Chills | 81 (16.5) | 37 (18.0) | 44 (15.5) | .468 |
| Headache | 54 (11.0) | 20 (9.7) | 34 (12.0) | .430 |
| Nausea/vomiting | 55 (11.2) | 25 (12.1) | 30 (10.6) | .586 |
| Myalgia | 46 (9.4) | 16 (7.8) | 30 (10.6) | .295 |
| Diarrhea | 38 (7.8) | 19 (9.2) | 19 (6.7) | .301 |
| Chest pain | 33 (6.7) | 18 (8.7) | 15 (5.3) | .132 |
| Arthralgia | 14 (2.9) | 4 (1.9) | 10 (3.5) | .300 |
| Hypoxia at presentation (≤92%) in room airf | 49 (10.6) | 43 (21.1)g | 6 (2.3)h | <.001 |
| Nosocomial infection | 20 (4.1) | 12 (5.8) | 8 (2.8) | .097 |
| Bronchoscopy | 42 (8.6) | 41 (19.9) | 1 (0.4) | <.001 |
| Lymphopenia (<200 cells/mL) | 60 (12.2) | 44 (21.4) | 16 (5.6) | <.001 |
| Neutropenia (<500 cells/mL) | 28 (5.7) | 19 (9.2) | 9 (3.2) | .004 |
| Lymphopenia and neutropenia | 17 (3.5) | 14 (6.8) | 3 (1.1) | .001 |
| Elevated creatinine (≥1.2 mg/dL) | 146 (29.8) | 80 (38.8) | 66 (23.2) | <.001 |
| Antiviral therapy | ||||
| Any therapy | 390 (79.6) | 184 (89.3) | 206 (72.5) | <.001 |
| Ribavirin | 142 (29.0) | 92 (44.7) | 50 (17.6) | <.001 |
| Oseltamiviri | 245 (50.0) | 91 (44.2) | 154 (54.2) | .028 |
| IVIG | 67 (13.7) | 54 (26.2) | 13 (4.6) | <.001 |
| Antiviral timing from symptom onset | ||||
| No treatment | 100 (20.4) | 22 (10.7) | 78 (27.5) | <.001 |
| Within 48 h | 139 (28.4) | 56 (27.2) | 83 (29.2) | |
| After 48 h | 251 (51.2) | 128 (62.1) | 123 (43.3) | |
| RVI outcomes | ||||
| Hospital admission | ||||
| Any | 280 (57.1) | 180 (87.4) | 100 (35.2) | <.001 |
| Secondary to RVI | 232 (47.3) | 154 (74.8) | 78 (27.5) | <.001 |
| Length of stay, d, median (IQR)j | 5 (3–9) | 7 (4–12) | 3 (2–5) | <.001 |
| ICU admission | 38 (7.8) | 36 (17.5) | 2 (0.7) | <.001 |
| Oxygen requirement (maximal) | ||||
| None | 332 (67.8) | 74 (35.8) | 258 (90.8) | <.001 |
| Nasal cannula | 98 (20.0) | 72 (35.0) | 26 (9.2) | |
| Face mask | 8 (1.6) | 8 (3.9) | 0 (0.0) | |
| HFNC | 20 (4.1) | 20 (9.7) | 0 (0.0) | |
| BiPAP | 15 (3.1) | 15 (7.3) | 0 (0.0) | |
| Mechanical ventilation | 17 (3.5) | 17 (8.3) | 0 (0.0) | |
| Follow-up duration, d, median (IQR) | 90 (90–90) | 90 (90–90) | 90 (90–90) | <.001 |
| 30-d all-cause mortality | 20 (4.1) | 20 (9.7) | 0 (0.0) | <.001 |
| 30-d RVI-related mortality | 19 (3.9) | 19 (9.2) | 0 (0.0) | <.001 |
| 90-d all-cause mortality | 32 (6.5) | 27 (13.1) | 5 (1.8) | <.001 |
| Variablea . | Total (N = 490) . | LRI (n = 206) . | URI (n = 284) . | P Value . |
|---|---|---|---|---|
| Demographics | ||||
| Age at RVI diagnosis, y, mean ± SD | 61.8 ± 13.8 | 63.9 ± 13.2 | 60.2 ± 14.0 | .003 |
| Sex | ||||
| Female | 216 (44.1) | 90 (43.7) | 126 (44.4) | .882 |
| Male | 274 (55.9) | 116 (56.3) | 158 (55.6) | |
| Race/ethnicity | ||||
| Non-Hispanic White | 277 (56.5) | 116 (56.3) | 161 (56.6) | .840 |
| Hispanic | 88 (18.0) | 39 (18.9) | 49 (17.3) | |
| Black | 92 (18.8) | 40 (19.4) | 52 (18.3) | |
| Asian | 29 (5.9) | 10 (4.9) | 19 (6.7) | |
| Other | 4 (0.8) | 1 (0.5) | 3 (1.1) | |
| Smoking statusb | ||||
| Never | 314 (64.2) | 119 (58.1) | 195 (68.7) | .048 |
| Former | 161 (32.9) | 80 (39.0) | 81 (28.5) | |
| Current | 14 (2.9) | 6 (2.9) | 8 (2.8) | |
| Influenza vaccination (current season) | 130 (26.5) | 51 (24.8) | 79 (27.8) | .449 |
| HM characteristics | ||||
| HM diagnosis | ||||
| Hodgkin lymphoma | 31 (6.3) | 11 (5.3) | 20 (7.0) | .163 |
| Non-Hodgkin lymphoma | 162 (33.1) | 60 (29.1) | 102 (35.9) | |
| Multiple myeloma | 297 (60.6) | 135 (65.6) | 162 (57.1) | |
| Active malignancy at RVI diagnosis | 351 (71.6) | 167 (81.1) | 184 (64.8) | <.001 |
| Active antineoplastic treatment at RVI diagnosis | 385 (78.6) | 174 (84.5) | 211 (74.3) | .007 |
| Steroid use within 30 d of RVI diagnosis (mg prednisone equivalent) | ||||
| Any | 296 (60.4) | 151 (73.3) | 145 (51.1) | <.001 |
| 30-d cumulative steroid dosage, median (IQR)c | 533 (240–1066) | 533 (266–997) | 533 (172–1066) | .597 |
| Peak dose of ≤1 mg/kg/dd | 86 (29.2) | 43 (28.5) | 43 (29.9) | .794 |
| Peak dose of >1 mg/kg/dd | 209 (70.8) | 108 (71.5) | 101 (70.1) | |
| Previous chest radiotherapy | 96 (19.6) | 47 (22.8) | 49 (17.3) | .126 |
| History of HCT | ||||
| None | 266 (54.3) | 107 (51.9) | 159 (56.0) | .395 |
| Autologous | 214 (43.7) | 93 (45.2) | 121 (42.6) | |
| Allogeneic | 10 (2.0) | 6 (2.9) | 4 (1.4) | |
| History of CAR-T therapy | 36 (7.3) | 11 (5.3) | 25 (8.8) | .147 |
| RVI clinical course | ||||
| Pathogen | .006 | |||
| RSV | 232 (47.3) | 112 (54.4) | 120 (42.3) | |
| Influenza | 256 (52.3) | 92 (44.6) | 164 (57.7) | |
| RSV + influenza | 2 (0.4) | 2 (1.0) | 0 (0.0) | |
| Respiratory viral coinfections (during ±2 wk)e | 85 (17.3) | 40 (19.4) | 45 (15.8) | .303 |
| Year of infection | ||||
| 2016 | 45 (9.2) | 27 (13.1) | 18 (6.3) | .132 |
| 2017 | 98 (20.0) | 35 (17.0) | 63 (22.3) | |
| 2018 | 73 (14.9) | 34 (16.5) | 39 (13.7) | |
| 2019 | 115 (23.5) | 47 (22.8) | 68 (23.9) | |
| 2020 | 53 (10.8) | 19 (9.2) | 34 (12.0) | |
| 2021 | 36 (7.3) | 17 (8.3) | 19 (6.7) | |
| 2022 | 70 (14.3) | 27 (13.1) | 43 (15.1) | |
| Time period of infection | ||||
| Pre-COVID-19 era (Jan 2016–Feb 2020) | 376 (76.7) | 158 (76.7) | 218 (76.8) | .987 |
| COVID-19 era (Mar 2020–Dec 2022) | 114 (23.3) | 48 (23.3) | 66 (23.2) | |
| LRI typec | ||||
| Probable | … | 170 (82.5) | … | |
| Laboratory confirmed | … | 36 (17.5) | … | |
| RVI symptoms | ||||
| Cough | 428 (87.3) | 184 (89.3) | 244 (85.9) | .263 |
| Fever | 250 (51.0) | 116 (56.3) | 134 (47.2) | .046 |
| Shortness of breath | 162 (33.1) | 95 (46.1) | 67 (23.6) | <.001 |
| Rhinorrhea | 148 (30.2) | 40 (19.4) | 108 (38.0) | <.001 |
| Nasal congestion | 151 (30.8) | 51 (24.8) | 100 (35.2) | .013 |
| Fatigue | 149 (30.4) | 69 (33.5) | 80 (28.2) | .206 |
| Sore throat | 73 (14.9) | 26 (12.6) | 47 (16.5) | .228 |
| Chills | 81 (16.5) | 37 (18.0) | 44 (15.5) | .468 |
| Headache | 54 (11.0) | 20 (9.7) | 34 (12.0) | .430 |
| Nausea/vomiting | 55 (11.2) | 25 (12.1) | 30 (10.6) | .586 |
| Myalgia | 46 (9.4) | 16 (7.8) | 30 (10.6) | .295 |
| Diarrhea | 38 (7.8) | 19 (9.2) | 19 (6.7) | .301 |
| Chest pain | 33 (6.7) | 18 (8.7) | 15 (5.3) | .132 |
| Arthralgia | 14 (2.9) | 4 (1.9) | 10 (3.5) | .300 |
| Hypoxia at presentation (≤92%) in room airf | 49 (10.6) | 43 (21.1)g | 6 (2.3)h | <.001 |
| Nosocomial infection | 20 (4.1) | 12 (5.8) | 8 (2.8) | .097 |
| Bronchoscopy | 42 (8.6) | 41 (19.9) | 1 (0.4) | <.001 |
| Lymphopenia (<200 cells/mL) | 60 (12.2) | 44 (21.4) | 16 (5.6) | <.001 |
| Neutropenia (<500 cells/mL) | 28 (5.7) | 19 (9.2) | 9 (3.2) | .004 |
| Lymphopenia and neutropenia | 17 (3.5) | 14 (6.8) | 3 (1.1) | .001 |
| Elevated creatinine (≥1.2 mg/dL) | 146 (29.8) | 80 (38.8) | 66 (23.2) | <.001 |
| Antiviral therapy | ||||
| Any therapy | 390 (79.6) | 184 (89.3) | 206 (72.5) | <.001 |
| Ribavirin | 142 (29.0) | 92 (44.7) | 50 (17.6) | <.001 |
| Oseltamiviri | 245 (50.0) | 91 (44.2) | 154 (54.2) | .028 |
| IVIG | 67 (13.7) | 54 (26.2) | 13 (4.6) | <.001 |
| Antiviral timing from symptom onset | ||||
| No treatment | 100 (20.4) | 22 (10.7) | 78 (27.5) | <.001 |
| Within 48 h | 139 (28.4) | 56 (27.2) | 83 (29.2) | |
| After 48 h | 251 (51.2) | 128 (62.1) | 123 (43.3) | |
| RVI outcomes | ||||
| Hospital admission | ||||
| Any | 280 (57.1) | 180 (87.4) | 100 (35.2) | <.001 |
| Secondary to RVI | 232 (47.3) | 154 (74.8) | 78 (27.5) | <.001 |
| Length of stay, d, median (IQR)j | 5 (3–9) | 7 (4–12) | 3 (2–5) | <.001 |
| ICU admission | 38 (7.8) | 36 (17.5) | 2 (0.7) | <.001 |
| Oxygen requirement (maximal) | ||||
| None | 332 (67.8) | 74 (35.8) | 258 (90.8) | <.001 |
| Nasal cannula | 98 (20.0) | 72 (35.0) | 26 (9.2) | |
| Face mask | 8 (1.6) | 8 (3.9) | 0 (0.0) | |
| HFNC | 20 (4.1) | 20 (9.7) | 0 (0.0) | |
| BiPAP | 15 (3.1) | 15 (7.3) | 0 (0.0) | |
| Mechanical ventilation | 17 (3.5) | 17 (8.3) | 0 (0.0) | |
| Follow-up duration, d, median (IQR) | 90 (90–90) | 90 (90–90) | 90 (90–90) | <.001 |
| 30-d all-cause mortality | 20 (4.1) | 20 (9.7) | 0 (0.0) | <.001 |
| 30-d RVI-related mortality | 19 (3.9) | 19 (9.2) | 0 (0.0) | <.001 |
| 90-d all-cause mortality | 32 (6.5) | 27 (13.1) | 5 (1.8) | <.001 |
The difference in follow-up duration is more clearly illustrated when presented as the mean ± SD rather than the median and IQR. In the URI group, the mean duration was 85.4 ± 18.5 years, compared to 78.2 ± 26.5 years in the LRI group. P values less than .05 are indicated in bold format.
Abbreviations: BiPAP, bilevel positive airway pressure; CAR-T, chimeric antigen receptor T-cell; COVID-19, coronavirus disease 2019; HCT, hematopoietic stem cell transplantation; HFNC, high-flow nasal cannula; HM, hematologic malignancy; ICU, intensive care unit; IQR, interquartile range; IVIG, intravenous immunoglobulin; LRI, lower respiratory tract infection; RSV, respiratory syncytial virus; RVI, respiratory virus infection; SD, standard deviation; URI, upper respiratory tract infection.
aData are presented as No. (%) unless otherwise specified.
bn = 489.
cn = 294.
dn = 295.
eViral coinfections included rhinovirus (n = 34), seasonal human coronavirus (non–severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) (n = 31), SARS-CoV-2 (n = 4), parainfluenza (n = 10), human metapneumovirus (n = 7), adenovirus (n = 1), and cytomegalovirus pneumonitis (n = 3).
fn = 462.
gn = 204.
hn = 258.
iThree RSV-infected patients were treated empirically with oseltamivir before the respiratory virus panel results were received.
jn = 280.
This PDF is available to Subscribers Only
View Article Abstract & Purchase OptionsFor full access to this pdf, sign in to an existing account, or purchase an annual subscription.
