Researchers have developed a novel risk score for the progression of human rhinovirus (HRV) from upper respiratory tract infection (URTI) to lower respiratory tract infection (LRTI) in patients who received hematopoietic cell transplantation (HCT).
In a report published in Biology of Blood and Marrow Transplantation, researchers retrospectively identified patients who received HCT at the Fred Hutchinson Cancer Research Center in Seattle, Washington, between January 1, 2009, and April 1, 2016.
Of 3445 HCT patients, 732 (21%) were HRV-positive and experienced 782 HRV illness events. Of these 782 events, 665 (85%) presented as an URTI and 117 (15%) as a LRTI. Complete data were available for 588 of 665 URTIs, which were used for the progression analysis.
The median age of patients with a URTI was 42.8 years (interquartile range [IQR], 22.2-57.7). URTI was more common in men (59%). Progression to LRTI occurred for 17% (100/588) of URTI events, with a median time to progression from URTI to LRTI of 12 days (IQR, 7-22).
The probability of progression from upper to lower HRV infection was estimated using cumulative incidence. In their final model, a risk score cutoff of 27 had the highest sensitivity (57%) and specificity (71%) and corresponded to positive and negative predictive values of 28% and 89%, respectively. The cumulative incidence of progression to LRTI for patients with a risk score of at least 27 was 28% compared with 11% for patients with a score of less than 27 (log-rank P <.001).
This novel risk score may serve as a tool to help stratify patients after HCT, when mortality rates from HRV LRTI are high. The authors noted that the optimal score cutoff depends on the application and can be adjusted accordingly.
1. Waghmare A, Xie H, Kuypers J, et al. Human rhinovirus infections in hematopoietic cell transplant recipients: risk score for progression to lower respiratory tract infection [published online December 8, 2018]. Biol Blood Marrow Transplant. doi: 10.1016/j.bbmt.2018.12.005