Characteristics of Patients With Respiratory Syncytial Virus (RSV) Lower Respiratory Disease, Including Subgroups Tested for Presence of RSV RNA in Blood
| Variable . | All Patients . | Patients With RSV RNA Detection Performed . | Patients Without RSV RNA Detection Performed . |
|---|---|---|---|
| (N = 118) . | (n = 92) . | (n = 26) . | |
| Age, y, median (IQR) | 42 (32–52) | 42 (32.5–52) | 39 (24–51) |
| Age, y | |||
| <21 | 11 (9%) | 6 (7%) | 5 (19%) |
| 21–60 | 94 (80%) | 75 (81%) | 19 (73%) |
| >60 | 13 (11%) | 11 (12%) | 2 (8%) |
| Sexa | |||
| Female | 43 (36%) | 29 (32%) | 14 (54%) |
| Male | 75 (64%) | 63 (68%) | 12 (46%) |
| Year of transplant | |||
| 1989–1997 | 69 (59%) | 56 (61%) | 13 (50%) |
| 1998–2010 | 49 (41%) | 36 (39%) | 13 (50%) |
| Race | |||
| Unknown | 4 (3%) | 3 (3%) | 1 (4%) |
| White | 99 (85%) | 77 (84%) | 22 (88%) |
| Nonwhite | 14 (12%) | 12 (13%) | 2 (8%) |
| Disease riskb | |||
| High | 58 (49%) | 47 (51%) | 11 (42%) |
| Standard | 60 (51%) | 45 (49%) | 15 (58%) |
| Cell source groups | |||
| PBSC | 51 (43%) | 36 (39%) | 15 (58%) |
| BM/CBc | 67 (57%) | 56 (61%) | 11 (42%) |
| Donor type | |||
| Allogeneic | 96 (81%) | 76 (83%) | 20 (77%) |
| Autologous | 22 (19%) | 16 (17%) | 6 (23%) |
| Conditioning regimen | |||
| MA ± low TBI | 44 (37%) | 34 (37%) | 10 (39%) |
| MA + TBI (≥12 Gy) | 56 (48%) | 44 (48%) | 12 (46%) |
| Nonmyeloablative | 18 (15%) | 14 (15%) | 4 (15%) |
| Pulmonary infiltrates | |||
| None | 23 (19%) | 19 (21%) | 4 (15%) |
| CXR or CT infiltrate | 95 (81%) | 73 (79%) | 22 (85%) |
| WBC count, 106 cells/L | |||
| >1000 | 75 (64%) | 58 (63%) | 17 (65%) |
| ≤1000 | 43 (36%) | 34 (37%) | 9 (35%) |
| Lymphocyte count, 106 cells/L | |||
| ≥100 | 83 (70%) | 63 (69%) | 20 (77%) |
| <100 | 35 (30%) | 29 (31%) | 6 (23%) |
| Neutrophil count, 106 cells/L | |||
| ≥100 | 90 (76%) | 72 (78%) | 18 (69%) |
| <100 | 28 (24%) | 20 (22%) | 8 (31%) |
| Monocyte count, 106 cells/L | |||
| ≥100 | 53 (49%) | 38 (46%) | 15 (58%) |
| <100 | 55 (51%) | 44 (54%) | 11 (42%) |
| Platelet count, 106 cells/L | |||
| ≥10 000 | 85 (72%) | 90 (76%) | 21 (81%) |
| <10 000 | 33 (28%) | 28 (24%) | 5 (19%) |
| Copathogend | |||
| None | 69 (59%) | 55 (60%) | 14 (54%) |
| Any copathogen | 49 (41%) | 37 (40%) | 12 (46%) |
| Oxygen at diagnosis of LRD | |||
| None to ≤2 L | 70 (59%) | 53 (58%) | 17 (65%) |
| >2 L/ventilatore | 48 (41%) | 39 (42%) | 9 (35%) |
| Steroid use at diagnosis of LRD | |||
| ≤2 mg/kg | 106 (90%) | 82 (89%) | 24 (92%) |
| >2 mg/kg | 12 (10%) | 10 (11%) | 2 (8%) |
| Palivizumab | |||
| No | 76 (64%) | 60 (65%) | 16 (62%) |
| Yes | 42 (36%) | 32 (35%) | 10 (38%) |
| IVIGf | |||
| No | 69 (58%) | 57 (62%) | 12 (46%) |
| Yes | 49 (42%) | 35 (38%) | 14 (54%) |
| Preemptive ribavirin prior to LRD | |||
| None | 92 (78%) | 69 (75%) | 23 (88%) |
| <5 d | 10 (8%) | 9 (10%) | 1 (4%) |
| ≥5 d | 16 (14%) | 14 (15%) | 2 (8%) |
| Ribavirin treatment for LRD | |||
| None | 17 (14%) | 16 (17%) | 1 (4%) |
| Systemicg | 13 (11%) | 11 (12%) | 2 (8%) |
| Aerosolizedh | 88 (75%) | 65 (71%) | 23 (88%)i |
| FEV/FVC % prior to RSV LRD | |||
| ≥70 | 90 (81%) | 71 (81%) | 19 (83%) |
| <70 | 21 (19%) | 17 (19%) | 4 (17%) |
| TLC % prior to RSV LRD | |||
| ≥80 | 96 (95%) | 78 (95%) | 18 (95%) |
| <80 | 5 (5%) | 4 (5%) | 1 (5%) |
| Variable . | All Patients . | Patients With RSV RNA Detection Performed . | Patients Without RSV RNA Detection Performed . |
|---|---|---|---|
| (N = 118) . | (n = 92) . | (n = 26) . | |
| Age, y, median (IQR) | 42 (32–52) | 42 (32.5–52) | 39 (24–51) |
| Age, y | |||
| <21 | 11 (9%) | 6 (7%) | 5 (19%) |
| 21–60 | 94 (80%) | 75 (81%) | 19 (73%) |
| >60 | 13 (11%) | 11 (12%) | 2 (8%) |
| Sexa | |||
| Female | 43 (36%) | 29 (32%) | 14 (54%) |
| Male | 75 (64%) | 63 (68%) | 12 (46%) |
| Year of transplant | |||
| 1989–1997 | 69 (59%) | 56 (61%) | 13 (50%) |
| 1998–2010 | 49 (41%) | 36 (39%) | 13 (50%) |
| Race | |||
| Unknown | 4 (3%) | 3 (3%) | 1 (4%) |
| White | 99 (85%) | 77 (84%) | 22 (88%) |
| Nonwhite | 14 (12%) | 12 (13%) | 2 (8%) |
| Disease riskb | |||
| High | 58 (49%) | 47 (51%) | 11 (42%) |
| Standard | 60 (51%) | 45 (49%) | 15 (58%) |
| Cell source groups | |||
| PBSC | 51 (43%) | 36 (39%) | 15 (58%) |
| BM/CBc | 67 (57%) | 56 (61%) | 11 (42%) |
| Donor type | |||
| Allogeneic | 96 (81%) | 76 (83%) | 20 (77%) |
| Autologous | 22 (19%) | 16 (17%) | 6 (23%) |
| Conditioning regimen | |||
| MA ± low TBI | 44 (37%) | 34 (37%) | 10 (39%) |
| MA + TBI (≥12 Gy) | 56 (48%) | 44 (48%) | 12 (46%) |
| Nonmyeloablative | 18 (15%) | 14 (15%) | 4 (15%) |
| Pulmonary infiltrates | |||
| None | 23 (19%) | 19 (21%) | 4 (15%) |
| CXR or CT infiltrate | 95 (81%) | 73 (79%) | 22 (85%) |
| WBC count, 106 cells/L | |||
| >1000 | 75 (64%) | 58 (63%) | 17 (65%) |
| ≤1000 | 43 (36%) | 34 (37%) | 9 (35%) |
| Lymphocyte count, 106 cells/L | |||
| ≥100 | 83 (70%) | 63 (69%) | 20 (77%) |
| <100 | 35 (30%) | 29 (31%) | 6 (23%) |
| Neutrophil count, 106 cells/L | |||
| ≥100 | 90 (76%) | 72 (78%) | 18 (69%) |
| <100 | 28 (24%) | 20 (22%) | 8 (31%) |
| Monocyte count, 106 cells/L | |||
| ≥100 | 53 (49%) | 38 (46%) | 15 (58%) |
| <100 | 55 (51%) | 44 (54%) | 11 (42%) |
| Platelet count, 106 cells/L | |||
| ≥10 000 | 85 (72%) | 90 (76%) | 21 (81%) |
| <10 000 | 33 (28%) | 28 (24%) | 5 (19%) |
| Copathogend | |||
| None | 69 (59%) | 55 (60%) | 14 (54%) |
| Any copathogen | 49 (41%) | 37 (40%) | 12 (46%) |
| Oxygen at diagnosis of LRD | |||
| None to ≤2 L | 70 (59%) | 53 (58%) | 17 (65%) |
| >2 L/ventilatore | 48 (41%) | 39 (42%) | 9 (35%) |
| Steroid use at diagnosis of LRD | |||
| ≤2 mg/kg | 106 (90%) | 82 (89%) | 24 (92%) |
| >2 mg/kg | 12 (10%) | 10 (11%) | 2 (8%) |
| Palivizumab | |||
| No | 76 (64%) | 60 (65%) | 16 (62%) |
| Yes | 42 (36%) | 32 (35%) | 10 (38%) |
| IVIGf | |||
| No | 69 (58%) | 57 (62%) | 12 (46%) |
| Yes | 49 (42%) | 35 (38%) | 14 (54%) |
| Preemptive ribavirin prior to LRD | |||
| None | 92 (78%) | 69 (75%) | 23 (88%) |
| <5 d | 10 (8%) | 9 (10%) | 1 (4%) |
| ≥5 d | 16 (14%) | 14 (15%) | 2 (8%) |
| Ribavirin treatment for LRD | |||
| None | 17 (14%) | 16 (17%) | 1 (4%) |
| Systemicg | 13 (11%) | 11 (12%) | 2 (8%) |
| Aerosolizedh | 88 (75%) | 65 (71%) | 23 (88%)i |
| FEV/FVC % prior to RSV LRD | |||
| ≥70 | 90 (81%) | 71 (81%) | 19 (83%) |
| <70 | 21 (19%) | 17 (19%) | 4 (17%) |
| TLC % prior to RSV LRD | |||
| ≥80 | 96 (95%) | 78 (95%) | 18 (95%) |
| <80 | 5 (5%) | 4 (5%) | 1 (5%) |
Data are presented No. (%) unless otherwise specified. Patients' demographic characteristics were compared using χ2 test or Fisher exact test for categorical variables, as appropriate.
Abbreviations: BM/CB, bone marrow/cord blood; CT, computed tomography; CXR, chest radiography; FEV, forced expiratory volume; FVC, forced vital capacity; IQR, interquartile range; IVIG, intravenous immunoglobulin; LRD, lower respiratory disease; MA, myeloablative; PBSC, peripheral blood stem cell; RSV, respiratory syncytial virus; TBI, total body irradiation; TLC, total lung capacity; WBC, white blood cell.
aP = .037.
b Underlying disease risk defined as previously described [29].
c Four cord blood, 63 bone marrow.
d Copathogens defined as pathogenic bacteria, fungi, or opportunistic viruses from bronchoalveolar lavage and/or blood obtained within 2 days of RSV LRD diagnosis.
e Including those requiring continuous positive airway pressure and mechanical ventilation.
f IVIG was administered at the discretion of the attending physician.
g Intravenously dosed as a loading dose (35 mg/kg in 3 divided doses every 8 hours) followed by a maintenance dose (25 mg/kg in 3 divided doses every 8 hours for 6 days) [30] or orally dosed as a loading dose (10 mg/kg) followed by 400 mg every 8 hours on day 2 and 600 mg every 8 hours on day 3 [31]. Oral, n = 4; intravenous, n = 9.
h Current practice guidelines at our center involve treatment with aerosolized ribavirin in all patients with RSV LRD, dosed as 6 g as a single dose over 18 hours or 2 g three times a day over 2 hours [15].
i Ten patients also received palivizumab; 9 patients also received IVIG.
Characteristics of Patients With Respiratory Syncytial Virus (RSV) Lower Respiratory Disease, Including Subgroups Tested for Presence of RSV RNA in Blood
| Variable . | All Patients . | Patients With RSV RNA Detection Performed . | Patients Without RSV RNA Detection Performed . |
|---|---|---|---|
| (N = 118) . | (n = 92) . | (n = 26) . | |
| Age, y, median (IQR) | 42 (32–52) | 42 (32.5–52) | 39 (24–51) |
| Age, y | |||
| <21 | 11 (9%) | 6 (7%) | 5 (19%) |
| 21–60 | 94 (80%) | 75 (81%) | 19 (73%) |
| >60 | 13 (11%) | 11 (12%) | 2 (8%) |
| Sexa | |||
| Female | 43 (36%) | 29 (32%) | 14 (54%) |
| Male | 75 (64%) | 63 (68%) | 12 (46%) |
| Year of transplant | |||
| 1989–1997 | 69 (59%) | 56 (61%) | 13 (50%) |
| 1998–2010 | 49 (41%) | 36 (39%) | 13 (50%) |
| Race | |||
| Unknown | 4 (3%) | 3 (3%) | 1 (4%) |
| White | 99 (85%) | 77 (84%) | 22 (88%) |
| Nonwhite | 14 (12%) | 12 (13%) | 2 (8%) |
| Disease riskb | |||
| High | 58 (49%) | 47 (51%) | 11 (42%) |
| Standard | 60 (51%) | 45 (49%) | 15 (58%) |
| Cell source groups | |||
| PBSC | 51 (43%) | 36 (39%) | 15 (58%) |
| BM/CBc | 67 (57%) | 56 (61%) | 11 (42%) |
| Donor type | |||
| Allogeneic | 96 (81%) | 76 (83%) | 20 (77%) |
| Autologous | 22 (19%) | 16 (17%) | 6 (23%) |
| Conditioning regimen | |||
| MA ± low TBI | 44 (37%) | 34 (37%) | 10 (39%) |
| MA + TBI (≥12 Gy) | 56 (48%) | 44 (48%) | 12 (46%) |
| Nonmyeloablative | 18 (15%) | 14 (15%) | 4 (15%) |
| Pulmonary infiltrates | |||
| None | 23 (19%) | 19 (21%) | 4 (15%) |
| CXR or CT infiltrate | 95 (81%) | 73 (79%) | 22 (85%) |
| WBC count, 106 cells/L | |||
| >1000 | 75 (64%) | 58 (63%) | 17 (65%) |
| ≤1000 | 43 (36%) | 34 (37%) | 9 (35%) |
| Lymphocyte count, 106 cells/L | |||
| ≥100 | 83 (70%) | 63 (69%) | 20 (77%) |
| <100 | 35 (30%) | 29 (31%) | 6 (23%) |
| Neutrophil count, 106 cells/L | |||
| ≥100 | 90 (76%) | 72 (78%) | 18 (69%) |
| <100 | 28 (24%) | 20 (22%) | 8 (31%) |
| Monocyte count, 106 cells/L | |||
| ≥100 | 53 (49%) | 38 (46%) | 15 (58%) |
| <100 | 55 (51%) | 44 (54%) | 11 (42%) |
| Platelet count, 106 cells/L | |||
| ≥10 000 | 85 (72%) | 90 (76%) | 21 (81%) |
| <10 000 | 33 (28%) | 28 (24%) | 5 (19%) |
| Copathogend | |||
| None | 69 (59%) | 55 (60%) | 14 (54%) |
| Any copathogen | 49 (41%) | 37 (40%) | 12 (46%) |
| Oxygen at diagnosis of LRD | |||
| None to ≤2 L | 70 (59%) | 53 (58%) | 17 (65%) |
| >2 L/ventilatore | 48 (41%) | 39 (42%) | 9 (35%) |
| Steroid use at diagnosis of LRD | |||
| ≤2 mg/kg | 106 (90%) | 82 (89%) | 24 (92%) |
| >2 mg/kg | 12 (10%) | 10 (11%) | 2 (8%) |
| Palivizumab | |||
| No | 76 (64%) | 60 (65%) | 16 (62%) |
| Yes | 42 (36%) | 32 (35%) | 10 (38%) |
| IVIGf | |||
| No | 69 (58%) | 57 (62%) | 12 (46%) |
| Yes | 49 (42%) | 35 (38%) | 14 (54%) |
| Preemptive ribavirin prior to LRD | |||
| None | 92 (78%) | 69 (75%) | 23 (88%) |
| <5 d | 10 (8%) | 9 (10%) | 1 (4%) |
| ≥5 d | 16 (14%) | 14 (15%) | 2 (8%) |
| Ribavirin treatment for LRD | |||
| None | 17 (14%) | 16 (17%) | 1 (4%) |
| Systemicg | 13 (11%) | 11 (12%) | 2 (8%) |
| Aerosolizedh | 88 (75%) | 65 (71%) | 23 (88%)i |
| FEV/FVC % prior to RSV LRD | |||
| ≥70 | 90 (81%) | 71 (81%) | 19 (83%) |
| <70 | 21 (19%) | 17 (19%) | 4 (17%) |
| TLC % prior to RSV LRD | |||
| ≥80 | 96 (95%) | 78 (95%) | 18 (95%) |
| <80 | 5 (5%) | 4 (5%) | 1 (5%) |
| Variable . | All Patients . | Patients With RSV RNA Detection Performed . | Patients Without RSV RNA Detection Performed . |
|---|---|---|---|
| (N = 118) . | (n = 92) . | (n = 26) . | |
| Age, y, median (IQR) | 42 (32–52) | 42 (32.5–52) | 39 (24–51) |
| Age, y | |||
| <21 | 11 (9%) | 6 (7%) | 5 (19%) |
| 21–60 | 94 (80%) | 75 (81%) | 19 (73%) |
| >60 | 13 (11%) | 11 (12%) | 2 (8%) |
| Sexa | |||
| Female | 43 (36%) | 29 (32%) | 14 (54%) |
| Male | 75 (64%) | 63 (68%) | 12 (46%) |
| Year of transplant | |||
| 1989–1997 | 69 (59%) | 56 (61%) | 13 (50%) |
| 1998–2010 | 49 (41%) | 36 (39%) | 13 (50%) |
| Race | |||
| Unknown | 4 (3%) | 3 (3%) | 1 (4%) |
| White | 99 (85%) | 77 (84%) | 22 (88%) |
| Nonwhite | 14 (12%) | 12 (13%) | 2 (8%) |
| Disease riskb | |||
| High | 58 (49%) | 47 (51%) | 11 (42%) |
| Standard | 60 (51%) | 45 (49%) | 15 (58%) |
| Cell source groups | |||
| PBSC | 51 (43%) | 36 (39%) | 15 (58%) |
| BM/CBc | 67 (57%) | 56 (61%) | 11 (42%) |
| Donor type | |||
| Allogeneic | 96 (81%) | 76 (83%) | 20 (77%) |
| Autologous | 22 (19%) | 16 (17%) | 6 (23%) |
| Conditioning regimen | |||
| MA ± low TBI | 44 (37%) | 34 (37%) | 10 (39%) |
| MA + TBI (≥12 Gy) | 56 (48%) | 44 (48%) | 12 (46%) |
| Nonmyeloablative | 18 (15%) | 14 (15%) | 4 (15%) |
| Pulmonary infiltrates | |||
| None | 23 (19%) | 19 (21%) | 4 (15%) |
| CXR or CT infiltrate | 95 (81%) | 73 (79%) | 22 (85%) |
| WBC count, 106 cells/L | |||
| >1000 | 75 (64%) | 58 (63%) | 17 (65%) |
| ≤1000 | 43 (36%) | 34 (37%) | 9 (35%) |
| Lymphocyte count, 106 cells/L | |||
| ≥100 | 83 (70%) | 63 (69%) | 20 (77%) |
| <100 | 35 (30%) | 29 (31%) | 6 (23%) |
| Neutrophil count, 106 cells/L | |||
| ≥100 | 90 (76%) | 72 (78%) | 18 (69%) |
| <100 | 28 (24%) | 20 (22%) | 8 (31%) |
| Monocyte count, 106 cells/L | |||
| ≥100 | 53 (49%) | 38 (46%) | 15 (58%) |
| <100 | 55 (51%) | 44 (54%) | 11 (42%) |
| Platelet count, 106 cells/L | |||
| ≥10 000 | 85 (72%) | 90 (76%) | 21 (81%) |
| <10 000 | 33 (28%) | 28 (24%) | 5 (19%) |
| Copathogend | |||
| None | 69 (59%) | 55 (60%) | 14 (54%) |
| Any copathogen | 49 (41%) | 37 (40%) | 12 (46%) |
| Oxygen at diagnosis of LRD | |||
| None to ≤2 L | 70 (59%) | 53 (58%) | 17 (65%) |
| >2 L/ventilatore | 48 (41%) | 39 (42%) | 9 (35%) |
| Steroid use at diagnosis of LRD | |||
| ≤2 mg/kg | 106 (90%) | 82 (89%) | 24 (92%) |
| >2 mg/kg | 12 (10%) | 10 (11%) | 2 (8%) |
| Palivizumab | |||
| No | 76 (64%) | 60 (65%) | 16 (62%) |
| Yes | 42 (36%) | 32 (35%) | 10 (38%) |
| IVIGf | |||
| No | 69 (58%) | 57 (62%) | 12 (46%) |
| Yes | 49 (42%) | 35 (38%) | 14 (54%) |
| Preemptive ribavirin prior to LRD | |||
| None | 92 (78%) | 69 (75%) | 23 (88%) |
| <5 d | 10 (8%) | 9 (10%) | 1 (4%) |
| ≥5 d | 16 (14%) | 14 (15%) | 2 (8%) |
| Ribavirin treatment for LRD | |||
| None | 17 (14%) | 16 (17%) | 1 (4%) |
| Systemicg | 13 (11%) | 11 (12%) | 2 (8%) |
| Aerosolizedh | 88 (75%) | 65 (71%) | 23 (88%)i |
| FEV/FVC % prior to RSV LRD | |||
| ≥70 | 90 (81%) | 71 (81%) | 19 (83%) |
| <70 | 21 (19%) | 17 (19%) | 4 (17%) |
| TLC % prior to RSV LRD | |||
| ≥80 | 96 (95%) | 78 (95%) | 18 (95%) |
| <80 | 5 (5%) | 4 (5%) | 1 (5%) |
Data are presented No. (%) unless otherwise specified. Patients' demographic characteristics were compared using χ2 test or Fisher exact test for categorical variables, as appropriate.
Abbreviations: BM/CB, bone marrow/cord blood; CT, computed tomography; CXR, chest radiography; FEV, forced expiratory volume; FVC, forced vital capacity; IQR, interquartile range; IVIG, intravenous immunoglobulin; LRD, lower respiratory disease; MA, myeloablative; PBSC, peripheral blood stem cell; RSV, respiratory syncytial virus; TBI, total body irradiation; TLC, total lung capacity; WBC, white blood cell.
aP = .037.
b Underlying disease risk defined as previously described [29].
c Four cord blood, 63 bone marrow.
d Copathogens defined as pathogenic bacteria, fungi, or opportunistic viruses from bronchoalveolar lavage and/or blood obtained within 2 days of RSV LRD diagnosis.
e Including those requiring continuous positive airway pressure and mechanical ventilation.
f IVIG was administered at the discretion of the attending physician.
g Intravenously dosed as a loading dose (35 mg/kg in 3 divided doses every 8 hours) followed by a maintenance dose (25 mg/kg in 3 divided doses every 8 hours for 6 days) [30] or orally dosed as a loading dose (10 mg/kg) followed by 400 mg every 8 hours on day 2 and 600 mg every 8 hours on day 3 [31]. Oral, n = 4; intravenous, n = 9.
h Current practice guidelines at our center involve treatment with aerosolized ribavirin in all patients with RSV LRD, dosed as 6 g as a single dose over 18 hours or 2 g three times a day over 2 hours [15].
i Ten patients also received palivizumab; 9 patients also received IVIG.
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