Epidemiology of Acute Respiratory Distress Syndrome Following Hematopoietic Stem Cell Transplantation

Hemang Yadav, Matthew E. Nolan, John K. Bohman, Rodrigo Cartin-Ceba, Steve G. Peters, William Hogan, Ognjen Gajic, Daryl J Kor

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVES:: Pulmonary complications are common following hematopoietic stem cell transplantation. Numerous idiopathic post-transplantation pulmonary syndromes have been described. Patients at the severe end of this spectrum may present with hypoxemic respiratory failure and pulmonary infiltrates, meeting criteria for acute respiratory distress syndrome. The incidence and outcomes of acute respiratory distress syndrome in this setting are poorly characterized. DESIGN:: Retrospective cohort study. SETTING:: Mayo Clinic, Rochester, MN. PATIENTS:: Patients undergoing autologous and allogeneic hematopoietic stem cell transplantation between January 1, 2005, and December 31, 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Patients were screened for acute respiratory distress syndrome development within 1 year of hematopoietic stem cell transplantation. Acute respiratory distress syndrome adjudication was performed in accordance with the 2012 Berlin criteria. In total, 133 cases of acute respiratory distress syndrome developed in 2,635 patients undergoing hematopoietic stem cell transplantation (5.0%). Acute respiratory distress syndrome developed in 75 patients (15.6%) undergoing allogeneic hematopoietic stem cell transplantation and 58 patients (2.7%) undergoing autologous hematopoietic stem cell transplantation. Median time to acute respiratory distress syndrome development was 55.4 days (interquartile range, 15.1–139 d) in allogeneic hematopoietic stem cell transplantation and 14.2 days (interquartile range, 10.5–124 d) in autologous hematopoietic stem cell transplantation. Twenty-eight-day mortality was 46.6%. At 12 months following hematopoietic stem cell transplantation, 89 patients (66.9%) who developed acute respiratory distress syndrome had died. Only 7 of 133 acute respiratory distress syndrome cases met criteria for engraftment syndrome and 15 for diffuse alveolar hemorrhage. CONCLUSIONS:: Acute respiratory distress syndrome is a frequent complication following hematopoietic stem cell transplantation, dramatically influencing patient-important outcomes. Most cases of acute respiratory distress syndrome following hematopoietic stem cell transplantation do not meet criteria for a more specific post-transplantation pulmonary syndrome. These findings highlight the need to better understand the risk factors underlying acute respiratory distress syndrome in this population, thereby facilitating the development of effective prevention strategies.

Original languageEnglish (US)
JournalCritical Care Medicine
DOIs
StateAccepted/In press - Jan 20 2016

Fingerprint

Hematopoietic Stem Cell Transplantation
Adult Respiratory Distress Syndrome
Epidemiology
Lung
Transplantation
Berlin
Respiratory Insufficiency
Cohort Studies
Retrospective Studies
Hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Epidemiology of Acute Respiratory Distress Syndrome Following Hematopoietic Stem Cell Transplantation. / Yadav, Hemang; Nolan, Matthew E.; Bohman, John K.; Cartin-Ceba, Rodrigo; Peters, Steve G.; Hogan, William; Gajic, Ognjen; Kor, Daryl J.

In: Critical Care Medicine, 20.01.2016.

Research output: Contribution to journalArticle

@article{a3b9062845bc415d80f5ba6dffca52ab,
title = "Epidemiology of Acute Respiratory Distress Syndrome Following Hematopoietic Stem Cell Transplantation",
abstract = "OBJECTIVES:: Pulmonary complications are common following hematopoietic stem cell transplantation. Numerous idiopathic post-transplantation pulmonary syndromes have been described. Patients at the severe end of this spectrum may present with hypoxemic respiratory failure and pulmonary infiltrates, meeting criteria for acute respiratory distress syndrome. The incidence and outcomes of acute respiratory distress syndrome in this setting are poorly characterized. DESIGN:: Retrospective cohort study. SETTING:: Mayo Clinic, Rochester, MN. PATIENTS:: Patients undergoing autologous and allogeneic hematopoietic stem cell transplantation between January 1, 2005, and December 31, 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Patients were screened for acute respiratory distress syndrome development within 1 year of hematopoietic stem cell transplantation. Acute respiratory distress syndrome adjudication was performed in accordance with the 2012 Berlin criteria. In total, 133 cases of acute respiratory distress syndrome developed in 2,635 patients undergoing hematopoietic stem cell transplantation (5.0{\%}). Acute respiratory distress syndrome developed in 75 patients (15.6{\%}) undergoing allogeneic hematopoietic stem cell transplantation and 58 patients (2.7{\%}) undergoing autologous hematopoietic stem cell transplantation. Median time to acute respiratory distress syndrome development was 55.4 days (interquartile range, 15.1–139 d) in allogeneic hematopoietic stem cell transplantation and 14.2 days (interquartile range, 10.5–124 d) in autologous hematopoietic stem cell transplantation. Twenty-eight-day mortality was 46.6{\%}. At 12 months following hematopoietic stem cell transplantation, 89 patients (66.9{\%}) who developed acute respiratory distress syndrome had died. Only 7 of 133 acute respiratory distress syndrome cases met criteria for engraftment syndrome and 15 for diffuse alveolar hemorrhage. CONCLUSIONS:: Acute respiratory distress syndrome is a frequent complication following hematopoietic stem cell transplantation, dramatically influencing patient-important outcomes. Most cases of acute respiratory distress syndrome following hematopoietic stem cell transplantation do not meet criteria for a more specific post-transplantation pulmonary syndrome. These findings highlight the need to better understand the risk factors underlying acute respiratory distress syndrome in this population, thereby facilitating the development of effective prevention strategies.",
author = "Hemang Yadav and Nolan, {Matthew E.} and Bohman, {John K.} and Rodrigo Cartin-Ceba and Peters, {Steve G.} and William Hogan and Ognjen Gajic and Kor, {Daryl J}",
year = "2016",
month = "1",
day = "20",
doi = "10.1097/CCM.0000000000001617",
language = "English (US)",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Epidemiology of Acute Respiratory Distress Syndrome Following Hematopoietic Stem Cell Transplantation

AU - Yadav, Hemang

AU - Nolan, Matthew E.

AU - Bohman, John K.

AU - Cartin-Ceba, Rodrigo

AU - Peters, Steve G.

AU - Hogan, William

AU - Gajic, Ognjen

AU - Kor, Daryl J

PY - 2016/1/20

Y1 - 2016/1/20

N2 - OBJECTIVES:: Pulmonary complications are common following hematopoietic stem cell transplantation. Numerous idiopathic post-transplantation pulmonary syndromes have been described. Patients at the severe end of this spectrum may present with hypoxemic respiratory failure and pulmonary infiltrates, meeting criteria for acute respiratory distress syndrome. The incidence and outcomes of acute respiratory distress syndrome in this setting are poorly characterized. DESIGN:: Retrospective cohort study. SETTING:: Mayo Clinic, Rochester, MN. PATIENTS:: Patients undergoing autologous and allogeneic hematopoietic stem cell transplantation between January 1, 2005, and December 31, 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Patients were screened for acute respiratory distress syndrome development within 1 year of hematopoietic stem cell transplantation. Acute respiratory distress syndrome adjudication was performed in accordance with the 2012 Berlin criteria. In total, 133 cases of acute respiratory distress syndrome developed in 2,635 patients undergoing hematopoietic stem cell transplantation (5.0%). Acute respiratory distress syndrome developed in 75 patients (15.6%) undergoing allogeneic hematopoietic stem cell transplantation and 58 patients (2.7%) undergoing autologous hematopoietic stem cell transplantation. Median time to acute respiratory distress syndrome development was 55.4 days (interquartile range, 15.1–139 d) in allogeneic hematopoietic stem cell transplantation and 14.2 days (interquartile range, 10.5–124 d) in autologous hematopoietic stem cell transplantation. Twenty-eight-day mortality was 46.6%. At 12 months following hematopoietic stem cell transplantation, 89 patients (66.9%) who developed acute respiratory distress syndrome had died. Only 7 of 133 acute respiratory distress syndrome cases met criteria for engraftment syndrome and 15 for diffuse alveolar hemorrhage. CONCLUSIONS:: Acute respiratory distress syndrome is a frequent complication following hematopoietic stem cell transplantation, dramatically influencing patient-important outcomes. Most cases of acute respiratory distress syndrome following hematopoietic stem cell transplantation do not meet criteria for a more specific post-transplantation pulmonary syndrome. These findings highlight the need to better understand the risk factors underlying acute respiratory distress syndrome in this population, thereby facilitating the development of effective prevention strategies.

AB - OBJECTIVES:: Pulmonary complications are common following hematopoietic stem cell transplantation. Numerous idiopathic post-transplantation pulmonary syndromes have been described. Patients at the severe end of this spectrum may present with hypoxemic respiratory failure and pulmonary infiltrates, meeting criteria for acute respiratory distress syndrome. The incidence and outcomes of acute respiratory distress syndrome in this setting are poorly characterized. DESIGN:: Retrospective cohort study. SETTING:: Mayo Clinic, Rochester, MN. PATIENTS:: Patients undergoing autologous and allogeneic hematopoietic stem cell transplantation between January 1, 2005, and December 31, 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Patients were screened for acute respiratory distress syndrome development within 1 year of hematopoietic stem cell transplantation. Acute respiratory distress syndrome adjudication was performed in accordance with the 2012 Berlin criteria. In total, 133 cases of acute respiratory distress syndrome developed in 2,635 patients undergoing hematopoietic stem cell transplantation (5.0%). Acute respiratory distress syndrome developed in 75 patients (15.6%) undergoing allogeneic hematopoietic stem cell transplantation and 58 patients (2.7%) undergoing autologous hematopoietic stem cell transplantation. Median time to acute respiratory distress syndrome development was 55.4 days (interquartile range, 15.1–139 d) in allogeneic hematopoietic stem cell transplantation and 14.2 days (interquartile range, 10.5–124 d) in autologous hematopoietic stem cell transplantation. Twenty-eight-day mortality was 46.6%. At 12 months following hematopoietic stem cell transplantation, 89 patients (66.9%) who developed acute respiratory distress syndrome had died. Only 7 of 133 acute respiratory distress syndrome cases met criteria for engraftment syndrome and 15 for diffuse alveolar hemorrhage. CONCLUSIONS:: Acute respiratory distress syndrome is a frequent complication following hematopoietic stem cell transplantation, dramatically influencing patient-important outcomes. Most cases of acute respiratory distress syndrome following hematopoietic stem cell transplantation do not meet criteria for a more specific post-transplantation pulmonary syndrome. These findings highlight the need to better understand the risk factors underlying acute respiratory distress syndrome in this population, thereby facilitating the development of effective prevention strategies.

UR - http://www.scopus.com/inward/record.url?scp=84955578374&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955578374&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000001617

DO - 10.1097/CCM.0000000000001617

M3 - Article

C2 - 26807683

AN - SCOPUS:84955578374

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

ER -