title: Impact of corticosteroid treatment and antiviral therapy on clinical outcomes in hematopoietic cell transplant patients infected with influenza virus.
abstract: The impact of cytokines induced during influenza infection has been described, but the effect of corticosteroids on clinical outcomes is unclear. Although antiviral therapy has been well studied in immunocompetent subjects, few data exist on its clinical efficacy in immunocompromised populations. Data from 143 hematopoietic cell transplant recipients with documented seasonal influenza infection were reviewed to examine the impact of different corticosteroid regimens and antiviral therapy on clinical outcomes. In multivariable analyses, there was no observed difference between patients who received no, low doses (<1 mg/kg/day), or high doses (≥ 1 mg/kg/day) of corticosteroids with regard to the development of lower respiratory tract disease (LRD), hypoxemia, need for mechanical ventilation, or death. However, treatment with high-dose steroids was associated with a trend toward prolonged viral shedding (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.0-11; P = .05). In multivariable analyses, antiviral therapy initiated to treat upper respiratory tract infection (URI) was associated with fewer cases of LRD (OR, 0.04; 95% CI, 0-0.2; P < .01) and fewer hypoxemia episodes (OR, 0.3; 95% CI, 0.1-0.9; P = .03). Our results suggest that corticosteroids are not associated with adverse clinical outcomes in hematopoietic cell transplant recipients infected with influenza, although use of higher doses may delay viral clearance. Antiviral therapy initiated during the URI phase reduced the risk of LRD and hypoxemia.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle , WA 98109, USA. mboeckh@fhcrc.org
authors.forename: Alexandre A
authors.initials: AA
authors.lastname: Boudreault
authors.forename: Hu
authors.initials: H
authors.lastname: Xie
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.forename: Janet
authors.initials: J
authors.lastname: Englund
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D016207:Cytokines / Q000378:metabolism; D018450:Disease Progression; D004341:Drug Evaluation; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007251:Influenza, Human / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000188:drug therapy*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D017201:Virus Shedding / Q000187:drug effects; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D016207:Cytokines; D007166:Immunosuppressive Agents