Clinical characteristics and risk factors for death of respiratory syncytial virus infection in adult patients after hematopoietic stem cell transplantation

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Objective: To summarize the clinical features associated with respiratory syncytial virus (RSV) infection in patients following the hematopoietic stem cell transplant (HSCT) and exploring the risk factors for death. Methods: Patients who had RSV infection after undergoing HSCT from October 2023 to January 2024 in the hematology department of Peking University People's Hospital were enrolled in the study. The clinical characteristics of the participating patients were summarized. The clinical characteristics of the surviving and the dying patients were compared, and the risk factors of death were analyzed by binary logistic regression. Results: Among the 43 RSV-positive HSCT patients, 20 (46.5%) were hypoxemic, six (14.0%) were admitted to the ICU for further treatment, four (9.3%) required tracheal intubation assisted ventilation, and seven patients (16.3%) died. A comparison of the clinical features of the surviving patients and the deceased patients demonstrated that the deceased patients had a lower PLT when infected with RSV [74.5 (8.0-348.0) ×10(9)/L vs 15.0 (10.0-62.0) ×10(9)/L, P=0.003], a higher incidence of simultaneous bacterial infections (85.7% vs 41.7%, P=0.046), and a higher rate of hematological recurrence (71.4% vs 13.9%, P=0.004). Hematological recurrence (OR=15.500, 95% CI 2.336-102.848, P=0.005), influenza A viral infection (OR=14.000, 95%CI 1.064-184.182, P=0.045), and low PLT at the time of RSV infection (OR=0.945, 95% CI 0.894-0.999, P=0.048) were the factors associated with death following HSCT. Conclusion: Patients infected with RSV after undergoing HSCT have a poor prognosis, and active prevention and treatment of RSV in the autumn and winter requires urgent attention.