Risk stratification of immunocompromised children, including pediatric transplant recipients at risk of severe respiratory syncytial virus disease. (3rd January 2019) - Science, Michelle
Abstract: Background: Respiratory syncytial virus (RSV) infection is associated with increased morbidity and mortality in immunocompromised patients. Our goal was to develop a framework for risk stratifying immunocompromised patients, including transplant patients, for RSV prophylaxis. Methods: Risk factors for severe RSV disease in immunocompromised patients were identified in the literature and by an expert panel via survey. Experts assigned a probability of developing severe disease (0 to 100 scale) to the risk factors for each immunocompromised population. The results were validated using a clinical dataset. Linear mixed models adjusted for within‐expert clustering of ranks were used to estimate average scores, and differences were tested using paired t tests. Logistic regression was utilized to identify important determinants of severe RSV disease. Results: The survey was emailed to twenty‐seven experts and thirteen responded (48%). Across all transplant groups, age <2 years (mean 77.1, 95% CI 71.7, 82.5) and day care attendance (mean 72.8, 95% CI 67.3, 78.3) were assigned the highest risk of severe disease. The highest risk groups were lung transplant recipients (mean 73.2, 95% CI 67.6, 78.8), combined lung and heart transplant recipients (mean 75.2, 95% CI 69.6, 80.7), allogeneic stem cell transplant (mean 76.0, 95% CI 70.4, 81.6), and severe combined immunodeficiency (mean 74.7, 95% CI 69.1, 80.3). Conclusion: The results provide a logical validity to current practice and provide guidance for prioritizing patients to receive prophylactic agents to prevent severe RSV disease. The results will facilitate the development of a risk stratification tool for RSV prophylaxis for immunocompromised patients.