The following is the summary of “Post-Transplant and In-Hospital Risk Factors for ARDS After Hematopoietic Stem Cell Transplantation” published in the January 2023 issue of Respiratory Care by Herasevich, et al.
Acute respiratory distress syndrome (ARDS) is a devastating side effect of a hematopoietic stem cell transplant (HSCT). Risk factors for ARDS after HSCT that existed before the transplant have just recently been identified. The purpose of this research was to identify potential contributors to the increased risk of ARDS following HSCT. A nested case-control study was used. Based on age, transplantation type (allogeneic vs. autologous), and time since transplantation, ARDS cases were matched with hospitalized non-ARDS controls. Any relevant risk factors were adjusted a priori in a conditional logistic regression model for risk factors known to be linked with ARDS development.
A total of 170 patients diagnosed with ARDS were paired with 180 hospitalized controls who did not have ARDS. Steroid use before admission was significantly more common among cases (odds ratio [OR] 1.90 [1.13-3.19], P=.02). Cases had lower platelet counts, lower bicarbonates, and higher creatinine levels at admission (OR 0.91 [1.23-2.94], P=.004; 95% CI 0.95, 0.99). The odds of cases receiving a transfusion were 2.41 (95% CI: 1.48-3.94), opioids were 2.94 (95% CI: 1.67-5.18), and fluid administration was 1.52 (95% CI: 1.30-1.78), all P<.001.
Increased body temperature (OR 1.77 [1.34-2.33], P<.001) and increased breathing rate (OR 1.52 [1.33-1.74], P<.001) were seen in patients hospitalized with ARDS. Severe sepsis (odds ratio [OR] 68.0 [15.2-301.7], P<.001), bloodstream infection (OR] 4.59 [2.46-8.57], P<.001), and pneumonia (OR] 9.76 [5.01-19.00], P<.001) were all significantly associated with ARDS. Several pre-hospital and early in-hospital indicators of ARDS development following HSCT were discovered. These results can be utilized to create HSCT-specific risk prediction models and shed light on the mechanisms behind the onset of ARDS.