FACTORS ASSOCIATED WITH 30-DAY SURVIVAL FOLLOWING ACUTE RESPIRATORY FAILURE IN PATIENTS WITH ALLOGENIC BONE MARROW TRANSPLANTATION

Abstract

SESSION TITLE: Insights into the Care of Patients with Respiratory Failure SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Acute respiratory failure (ARF) complicating allogenic bone marrow transplantation (BMT) is still a major cause of mortality in allogenic BMT recipients. Post-BMT ARF occurs at different time phases, with infection, pulmonary edema, engraftment syndrome, and graft-versus-host disease being the most common etiologies. In this study, we aim to identify potential factors that could be associated with 30-day survival after ARF occurring within one year of allogenic BMT. METHODS: This is a single-center, retrospective study. Electronic medical records of patients who underwent allogenic BMT between 2008-2015 were reviewed. Among those, patients who were hospitalized for ARF within one year of BMT were identified. The following ARF criteria had to be met: (1) new requirement of supplemental oxygen, no-invasive positive pressure ventilation (NIPPV), or invasive mechanical ventilation (IMV); (2) new/worsening infiltrates on chest radiograph. For each patient, the following variables were identified: age, gender, race, body mass index, time from BMT to ARF (<30 days, 30-100 days, >100 days), BMT indication, initial respiratory support (supplemental oxygen, NIPPV, IMV), donor type, pre-existing lung disease, smoking history, length of hospitalization, whether bronchoscopy was done, and post-ARF 30-day survival. Association was tested using Pearson’s correlation for categorical variables, and logistic regression analysis for continuous variables. Two-Tail Exact Fischer’s test was used when indicated. Multivariate logistic regression analysis was used to adjust for significant variables. Statistical analysis was performed using JMP®. RESULTS: The charts of 188 patients were reviewed. Of those, 37 were included. 39% of the patients (n=14) were females, and the mean age was 50.6 years (±11). Crude analysis showed significant association between time from BMT to ARF and undergoing bronchoscopy on one side, and 30-day survival on the other side. In regards to BMT to ARF time, the highest 30-day survival was 77.8% (n= 14) in <30-day group, followed by 71.4% (n=5) in >100-day group, and 30% (n=3) in 30-100-day group (p=0.38). 30-day survival was 74.1% (n=20) in patients who underwent bronchoscopy compared to 25% (n=2) in those who didn’t have bronchoscopy (p=0.01). After adjusting for age, gender, and initial respiratory support, the association with having bronchoscopy stayed significant (p=0.01), whereas the association with BMT to ARF time became statistically non-significant (p=0.06). CONCLUSIONS: Performing bronchoscopy in allogenic BMT recipients who had ARF within one year of BMT is associated with higher post-ARF 30-day survival. There is a trend between BMT to ARF time and post ARF 30-day survival. CLINICAL IMPLICATIONS: Considering bronchoscopy in ARF complicating allogenic BMT could be meaningful in regards to 30-day survival. Further studies are needed to further clarify the nature of this association. DISCLOSURES: No relevant relationships by Hassan Baig, source=Web Response No relevant relationships by Faeq R Kukhon, source=Web Response No relevant relationships by Augustine Lee, source=Web Response