Journal article
Effect of cytomegalovirus infection on post-transplant hospitalization days among children undergoing allogeneic hematopoietic cell transplantation: A marginal structural model approach
Pediatric transplantation, v 28(1), pp e14526-n/a
Feb 2024
PMID: 37550269
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Cytomegalovirus (CMV) commonly reactivates after allogeneic hematopoietic cell transplant (HCT), potentially leading to CMV disease and significant morbidity and mortality. To reduce morbidity and mortality, many centers conduct weekly CMV blood polymerase chain reaction (PCR) surveillance testing with subsequent initiation of antiviral therapy upon CMV DNAemia detection. However, the impact of CMV DNAemia on subsequent hospitalization risk has not been assessed using models accounting for the time-varying nature of the exposure, outcome, and confounders.
All allogeneic HCTs at the Children's Hospital of Philadelphia from January 2004-April 2017 were considered for inclusion. Patients were monitored with CMV surveillance via PCR testing for up to 105 days after HCT receipt. We estimated the association between CMV DNAemia and rate of hospitalization using marginal structural models (MSM).
There were 343 allogeneic HCT episodes in 330 with CMV surveillance; median age was 9.0 (range: 0.1-26.2) and 46.5% were female. And 24.1% of HCT patients had at least one positive CMV blood PCR during the follow-up period. Median time to CMV DNAemia detection was 19 days (range: 4-97). The MSM estimated the incidence rate ratios for an association of CMV DNAemia with hospitalization to be 1.24, (95% confidence interval: 1.04-1.47).
CMV DNAemia was associated with an increased hospitalization in the post-HCT period. The MSM accounted for time-varying nature of the outcome, exposure and confounders. The findings support prevention of CMV DNAemia in this population. We recommend further investigation into the effectiveness and safety of prophylaxis versus pre-emptive CMV prevention approaches.
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Details
- Title
- Effect of cytomegalovirus infection on post-transplant hospitalization days among children undergoing allogeneic hematopoietic cell transplantation: A marginal structural model approach
- Creators
- Yun Li - University of PennsylvaniaDaniel T Vader - University of PennsylvaniaArman Oganisian - Brown UniversityCraig L K Boge - Children's Hospital of PhiladelphiaMolly Hayes - Children's Hospital of PhiladelphiaAnders Newman - UCSF Benioff Children's HospitalTim Olson - University of PennsylvaniaJason Freedman - University of PennsylvaniaCaitlin W Elgarten - University of PennsylvaniaBrian T Fisher - Children's Hospital of Philadelphia
- Publication Details
- Pediatric transplantation, v 28(1), pp e14526-n/a
- Publisher
- Wiley
- Grant note
- Fisher 57097 / Merck Investigator Studies Program
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:001043545700001
- Scopus ID
- 2-s2.0-85166922316
- Other Identifier
- 991021965355104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Pediatrics
- Transplantation