Impact of corticosteroid treatment and antiviral therapy on clinical outcomes in hematopoietic cell transplant patients infected with influenza virus

Abstract

The impact of cytokines induced during influenza infection has been described, but the effect of corticosteroids on clinical outcomes is unclear. Although antiviral therapy has been well studied in immunocompetent subjects, few data exist on its clinical efficacy in immunocompromised populations. Data from 143 hematopoietic cell transplant recipients with documented seasonal influenza infection were reviewed to examine the impact of different corticosteroid regimens and antiviral therapy on clinical outcomes. In multivariable analyses, there was no observed difference between patients who received no, low doses (<1 mg/kg/day), or high doses (≥ 1 mg/kg/day) of corticosteroids with regard to the development of lower respiratory tract disease (LRD), hypoxemia, need for mechanical ventilation, or death. However, treatment with high-dose steroids was associated with a trend toward prolonged viral shedding (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.0-11; P = .05). In multivariable analyses, antiviral therapy initiated to treat upper respiratory tract infection (URI) was associated with fewer cases of LRD (OR, 0.04; 95% CI, 0-0.2; P < .01) and fewer hypoxemia episodes (OR, 0.3; 95% CI, 0.1-0.9; P = .03). Our results suggest that corticosteroids are not associated with adverse clinical outcomes in hematopoietic cell transplant recipients infected with influenza, although use of higher doses may delay viral clearance. Antiviral therapy initiated during the URI phase reduced the risk of LRD and hypoxemia.

Figure 1

Kaplan-Meier analysis. Comparison of overall survival to 42 days after diagnosis of influenza infection in hematopoietic cell transplant recipients who were receiving either no corticosteroids, low dose corticosteroids (< 1 mg/kg or oral beclomethasone dipropionate) or high dose corticosteroids (≥ 1 mg/kg) at the time of infection. Log rank test P-value = 0.92.

Figure 2

Kaplan-Meier analysis. Comparison of overall survival to 42 days after diagnosis of influenza infection for hematopoietic cell transplant recipients who received antiviral therapy for upper respiratory tract infection versus those who did not received therapy. Log-rank test P-value = 0.03.