CORD-19-Sentences  

CORD-19:f389cba026d0cd5d8d1a63104d3e232d2b861cbb JSONTXT 7 Projects

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TextSentencer_T1 0-65 Sentence denotes Pulmonary complications in hematopoietic SCT: a prospective study
TextSentencer_T2 67-75 Sentence denotes Abstract
TextSentencer_T3 76-160 Sentence denotes Pulmonary complications are common and often lethal in hematopoietic SCT recipients.
TextSentencer_T4 161-388 Sentence denotes The objective of this prospective interventional study was to evaluate the etiology, diagnostic procedures, risk factors and outcome of pulmonary complications in a cohort of hematopoietic SCT recipients followed up for 1 year.
TextSentencer_T5 389-536 Sentence denotes For patients suffering from a pulmonary complication, a diagnostic algorithm that included non-invasive and bronchoscopic procedures was performed.
TextSentencer_T6 537-594 Sentence denotes We identified 73 pulmonary complications in 169 patients:
TextSentencer_T7 595-692 Sentence denotes 50 (68%) were pneumonias; 21 (29%) were non-infectious complications and 2 (3%) were undiagnosed.
TextSentencer_T8 693-837 Sentence denotes Viruses (particularly Rhinovirus) and bacteria (particularly P. aeruginosa) (28 and 26%, respectively) were the most common causes of pneumonia.
TextSentencer_T9 838-892 Sentence denotes A specific diagnosis was obtained in 83% of the cases.
TextSentencer_T10 893-962 Sentence denotes A non-invasive test gave a specific diagnosis in 59% of the episodes.
TextSentencer_T11 963-1039 Sentence denotes The diagnostic yield of bronchoscopy was 67 and 78% in pulmonary infections.
TextSentencer_T12 1040-1167 Sentence denotes Early bronchoscopy (⩽5 days) had higher diagnostic yield than late bronchoscopy (78 vs 23%; P = 0.02) for pulmonary infections.
TextSentencer_T13 1168-1255 Sentence denotes Overall mortality was 22 and 32% of all fatalities were due to pulmonary complications.
TextSentencer_T14 1256-1411 Sentence denotes Pulmonary complications are common and constitute an independent risk factor for mortality, stressing the importance of an appropriate clinical management.
TextSentencer_T15 1413-1717 Sentence denotes Pulmonary complications (PCs) are among the most common and lethal complications suffered by hematopoietic SCT (HSCT) patients. [1] [2] [3] [4] The increasing number of indications and the selection of more debilitated patients as potential candidates for HSCT seem to be changing the epidemiology of PC.
TextSentencer_T16 1718-1841 Sentence denotes 5, 6 Studies have shown that in immunocompromised patients an early identification of the etiology of PC improves survival.
TextSentencer_T17 1842-2298 Sentence denotes 7, 8 Fiberoptic bronchoscopy (FOB) has an important role in the diagnosis of PC; 9-12 however, detractors of this technique consider that the information provided may be also obtained by different non-invasive explorations. [13] [14] [15] The majority of the studies evaluating the etiology, diagnosis and prognosis of PC in patients with hematologic diseases are retrospective, 4, 6, 16 and include both non-transplantation and transplantation recipients.
TextSentencer_T18 2299-2424 Sentence denotes 2, 7 We hypothesized that the prospective follow-up of a cohort of HSCT recipients may improve the clinical management of PC.
TextSentencer_T19 2425-2579 Sentence denotes First, the knowledge of the epidemiology of the PC with the different prevalence of infectious and non-infectious etiologies can be accurately determined.
TextSentencer_T20 2580-2765 Sentence denotes Second, predetermined criteria for performing a FOB should clarify the role of this technique by better defining the diagnostic yield, clinical implications and potential complications.
TextSentencer_T21 2766-2927 Sentence denotes Finally, the identification of prognostic factors is much more precise when data are recorded prospectively in a homogeneous group of immunocompromised patients.
TextSentencer_T22 2928-3087 Sentence denotes The aim of this study was to evaluate the incidence, diagnostic and clinical implications of non-invasive and FOB explorations, risk factors and outcome of PC.
TextSentencer_T23 3088-3209 Sentence denotes To this aim, a cohort of consecutive patients requiring HSCT was followed-up for 1 year and the PC were closely analyzed.
TextSentencer_T24 3210-3393 Sentence denotes This is a prospective interventional study to evaluate the PC in a cohort of consecutive HSCT recipients; that was followed-up for 1 year (Figure 1 and see Supplementary Information).
TextSentencer_T25 3394-3552 Sentence denotes Different variables were recorded after the inclusion in the study and whenever a new respiratory complication was identified (see Supplementary Information).
TextSentencer_T26 3553-3824 Sentence denotes On the basis of the results of the diagnostic tests ( Figure 1 ) and the clinical judgment of the physician in charge, empirical treatment was initiated and a decision of whether or not the patient required hospital admission and further diagnostic explorations was made.
TextSentencer_T27 3825-4054 Sentence denotes Computed tomography was requested after 24-48 h of detection of positive aspergillus galactomannan antigen, after 4-5 days of persistent fever despite empirical treatment or prior to a FOB whenever this exploration was indicated.
TextSentencer_T28 4055-4138 Sentence denotes FOB was indicated after no response to 48-96 h of empirical treatment ( Figure 1 ).
TextSentencer_T29 4139-4295 Sentence denotes We defined early FOB when the procedure was performed ⩽ 5 days since the identification of the PC and late FOB when it was performed after this time period.
TextSentencer_T30 4296-4391 Sentence denotes 2 Patients were not eligible for FOB if arterial PaO2 was o60 mm Hg with oxygen administration.
TextSentencer_T31 4392-4746 Sentence denotes Bronchoscopic procedures included bronchial aspiration (diffuse aspiration of airway secretions) and bronchoalveolar lavage (BAL) that involves the instillation and subsequent aspiration of 100 mL of sterile saline solution in two aliquots (50 mL each) in the involved lobe or in the middle lobe or lingula in patients with diffuse pulmonary infiltrates.
TextSentencer_T32 4747-4859 Sentence denotes Other diagnostic techniques such as transbronchial biopsies were exceptionally carried out in selected patients.
TextSentencer_T33 4860-5198 Sentence denotes Specific primers for influenza viruses types A, B and C, respiratory syncytial virus type A and B, parainfluenza viruses 1, 2, 3 and 4 and adenovirus in one real-timePCR assay were performed in BAL and nasopharyngeal swab as described previously, and for generic detection of rhinoviruses and enteroviruses in another real-time-PCR assay.
TextSentencer_T34 5199-5266 Sentence denotes 17, 18 More details are described in the Supplementary Information.
TextSentencer_T35 5267-5428 Sentence denotes CMV detection in serum was done using a monoclonal antibody against the pp65-CMV protein (MonoFluo Kit CMV, Bio-Rad, Redmond, WA, USA) and culture or PCR in BAL.
TextSentencer_T36 5429-5601 Sentence denotes Detection of aspergillus galactomannan antigen in serum and BAL was performed using an enzyme immunoassay method (Platelia Aspergillus, Sanofi Diagnostics Pasteur, France).
TextSentencer_T37 5602-5807 Sentence denotes The etiology of PC was established based on the results of the diagnostic procedures performed, the response to the specific treatment and the histopathological evaluation of biopsy samples when available.
TextSentencer_T38 5808-5881 Sentence denotes PCs were further divided into infectious, non-infectious or undetermined.
TextSentencer_T39 5882-6074 Sentence denotes Pneumonia was defined as presence of fever (⩾38°C), cough, dyspnea, and/or purulent expectoration and a new or progressive pulmonary infiltrate not explained by any other non-infectious cause.
TextSentencer_T40 6075-6207 Sentence denotes 19 The diagnosis of viral pneumonia was confirmed with multiplex reverse transcription nested real-time-PCR assays performed in BAL.
TextSentencer_T41 6208-6272 Sentence denotes Mixed pneumonia was based on the identification of > 1 pathogen.
TextSentencer_T42 6273-6504 Sentence denotes The classification of proven, probable and possible aspergillosis was established based on definitions of the consensus of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group.
TextSentencer_T43 6505-6589 Sentence denotes 20 Pulmonary edema was diagnosed using both clinical and echocardiographic criteria.
TextSentencer_T44 6590-6758 Sentence denotes Cryptogenetic organizing pneumonia and drug-induced pulmonary toxicity were diagnosed histopathologically from samples obtained by transbronchial or open-lung biopsies.
TextSentencer_T45 6759-6819 Sentence denotes Engraftment syndrome was defined using the Spitzer criteria.
TextSentencer_T46 6820-6963 Sentence denotes 21 Capillary leak syndrome was defined as unexplained weight gain of > 3% within 24 h, generalized edema, and non-responsiveness to furosemide.
TextSentencer_T47 6964-7113 Sentence denotes 22 No response to empirical treatment: chest X-ray or computed tomography-scan revealing new or progressive lung infiltrates and/or persistent fever.
TextSentencer_T48 7114-7242 Sentence denotes Change in therapy: any addition or deletion to the treatment attributable to positive or negative results from the bronchoscopy.
TextSentencer_T49 7243-7354 Sentence denotes 15 Among patients who presented multiple complications, each episode was recorded and considered independently.
TextSentencer_T50 7355-7443 Sentence denotes Early/late PC was considered when appearing before or after 6 months of transplantation.
TextSentencer_T51 7444-7571 Sentence denotes The conditioning regimen, immunosuppressive and support therapies were administered following international accepted protocols.
TextSentencer_T52 7572-7700 Sentence denotes Nonmyeloablative regimens were used in patients older than 50 years, with relevant comorbidity or with previous transplantation.
TextSentencer_T53 7701-7786 Sentence denotes All allo-HSCT recipients received double-drug immunosuppression for GVHD prophylaxis.
TextSentencer_T54 7787-7858 Sentence denotes Donors and recipients were tested for CMV serology pre-transplantation.
TextSentencer_T55 7859-7961 Sentence denotes As anti-infective prophylaxis, levofloxacin was prescribed until engraftment and fluconazol until +75.
TextSentencer_T56 7962-8046 Sentence denotes Also, a preemptive strategy for CMV infections was followed according to guidelines.
TextSentencer_T57 8047-8104 Sentence denotes 23 HEPA-filtered rooms were always used during admission.
TextSentencer_T58 8105-8258 Sentence denotes We used n (%) for categorical variables and mean (s.d.) for continuous variables or median (interquartile range) for those with non-normal distributions.
TextSentencer_T59 8259-8326 Sentence denotes We compared categorical variables with χ 2 or Fisher's exact tests.
TextSentencer_T60 8327-8506 Sentence denotes The unpaired Student's t-test was used to compare quantitative continuous variables between groups; those with non-normal distribution were analyzed using the Mann-Whitney U-test.
TextSentencer_T61 8507-8658 Sentence denotes Univariate and multivariate logistic regression analyses were performed to investigate clinical factors associated with an increased risk of mortality.
TextSentencer_T62 8659-8801 Sentence denotes Variables that showed a significant result univariately (Po0.1) were included in the multivariate logistic regression backward stepwise model.
TextSentencer_T63 8802-8871 Sentence denotes Variables highly correlated were excluded from multivariate analyses.
TextSentencer_T64 8872-8966 Sentence denotes The Hosmer-Lemeshow goodness-of-fit test was performed to assess the overall fit of the model.
TextSentencer_T65 8967-9068 Sentence denotes 24 Survival curves were obtained using the Kalplan-Meier method and compared using the log-rank test.
TextSentencer_T66 9069-9124 Sentence denotes The level of significance was set at 0.05 (two tailed).
TextSentencer_T67 9125-9225 Sentence denotes All statistical analyses were done with SPSS version 18.0 (SPSS Inc., Chicago, IL, USA). (Table 1) .
TextSentencer_T68 9226-9448 Sentence denotes A total of 73 episodes of PC were identified in 51 patients (30% of the studied population) (35 patients presented 1 complication; 11 patients, 2 complications; 4 patients, 3 complications; and 1 patient, 4 complications).
TextSentencer_T69 9449-9524 Sentence denotes A specific diagnosis was obtained in 61 of the 73 episodes evaluated (83%).
TextSentencer_T70 9525-9693 Sentence denotes A total of 50 episodes of pneumonia (Table 2) were identified (68% of PC), most frequently viral (28% of lung infections), followed by bacterial (26%) and fungal (16%).
TextSentencer_T71 9694-9776 Sentence denotes Mixed infections (both bacterial and viral) were diagnosed in five episodes (10%).
TextSentencer_T72 9777-9939 Sentence denotes Rhinovirus and respiratory syncytial virus were the most frequent viruses isolated, and P. aeruginosa was the most frequently involved bacteria causing pneumonia.
TextSentencer_T73 9940-10076 Sentence denotes In particular, P. aeruginosa was involved in 27% of the diagnosed pulmonary infections (considering both isolated and mixed infections).
TextSentencer_T74 10077-10154 Sentence denotes Thirty-six percent of the isolated P. aeruginosa strains were multiresistant.
TextSentencer_T75 10155-10230 Sentence denotes Most of the infections occurred during the first 6 months after HSCT (80%).
TextSentencer_T76 10231-10412 Sentence denotes Seventeen out of the 50 (34%) patients suffering a pulmonary infection were neutropenic at diagnosis (15% of bacterial infections, 28% of viral infections and 60% mixed infections).
TextSentencer_T77 10413-10492 Sentence denotes Non-infectious PC (Table 3) were identified in 21 out of the 73 episodes (29%).
TextSentencer_T78 10493-10600 Sentence denotes Pulmonary edema (4/21, 19%) and underlying disease progression (4/21, 19%) were the most common etiologies.
TextSentencer_T79 10601-10756 Sentence denotes Transbronchial biopsies were performed in three patients with persistent pulmonary infiltrates after empirical treatment and a suspected non-infectious PC.
TextSentencer_T80 10757-10825 Sentence denotes There were no remarkable side effects after transbronchial biopsies.
TextSentencer_T81 10826-10921 Sentence denotes Also, one open-lung biopsy was required to diagnose a case of pharmacologic pulmonary toxicity.
TextSentencer_T82 10922-11007 Sentence denotes Eighty-one percent of the non-infectious pulmonary episodes were early complications.
TextSentencer_T83 11008-11153 Sentence denotes Of the PC diagnosed over the first month, 31% of the infectious and 27% of the non-infectious appeared in the first 7 days after transplantation.
TextSentencer_T84 11154-11301 Sentence denotes Diagnostic yield of non-invasive diagnostic techniques Sixteen (76%) non-infectious pulmonary episodes were diagnosed with non-invasive techniques.
TextSentencer_T85 11302-11418 Sentence denotes On the other hand, non-invasive tests gave a specific diagnostic in 27 episodes of pneumonia (54% of infectious PC).
TextSentencer_T86 11419-11473 Sentence denotes Specifically, blood cultures were positive in 9 (18%).
TextSentencer_T87 11474-11683 Sentence denotes Although, all the 14 viral pneumonias identified in our cohort were diagnosed by BAL, interestingly 11 of them also had concordant positive nasopharyngeal swab (diagnostic yield of nasopharyngeal swab of 75%).
TextSentencer_T88 11684-11753 Sentence denotes Four cases of S. pneumoniae were diagnosed by a urinary antigen test.
TextSentencer_T89 11754-11887 Sentence denotes One of these cases was also confirmed by blood culture, bronchial aspiration and BAL and other one had also a positive blood culture.
TextSentencer_T90 11888-11943 Sentence denotes Computed tomography was performed in 39 episodes (78%).
TextSentencer_T91 11944-12033 Sentence denotes In 12 cases (31%), the computed tomography was performed at the time the symptoms appear.
TextSentencer_T92 12034-12185 Sentence denotes The most common radiological finding in patients with bacterial pneumonia was consolidation (38%) and in viral pneumonia, ground-glass opacities (43%).
TextSentencer_T93 12186-12284 Sentence denotes Diagnostic yield of bronchoscopic techniques FOB was performed in 40 out of the 73 episodes (55%):
TextSentencer_T94 12285-12312 Sentence denotes 67% early and 33% late FOB.
TextSentencer_T95 12313-12571 Sentence denotes Reasons to perform a delayed FOB were: initial contraindication due to severe respiratory in five patients; progression of the pulmonary infiltrates in four patients and to assess pulmonary infiltrates finally diagnosed of non-infectious PC in four patients.
TextSentencer_T96 12572-12624 Sentence denotes The overall diagnostic yield of FOB was 67% (27/40).
TextSentencer_T97 12625-12703 Sentence denotes This percentage increased up to 78% (26/33) in patients with an infectious PC.
TextSentencer_T98 12704-12876 Sentence denotes Specific diagnosis obtained by FOB was: viral pneumonia in 13 patients, bacterial pneumonia in 6 patients, fungal pneumonia in 3 patients and mixed pneumonia in 4 patients.
TextSentencer_T99 12877-13025 Sentence denotes The diagnostic yield of the different endoscopic techniques, and the influence of the results obtained in treatment decisions are shown in Table 4 .
TextSentencer_T100 13026-13169 Sentence denotes The diagnostic yield of FOB for pulmonary infections was significantly higher when performed early (early FOB, 78% vs late FOB, 23%; P = 0.02).
TextSentencer_T101 13170-13289 Sentence denotes No differences between early and late FOB were evidenced as regards changes in empirical treatment (44 vs 38%; P = NS).
TextSentencer_T102 13290-13338 Sentence denotes There were no remarkable side effects after FOB.
TextSentencer_T103 13339-13435 Sentence denotes Figure 2 illustrates the diagnostic yield of non-invasive tests and FOB on pulmonary infections.
TextSentencer_T104 13436-13503 Sentence denotes Abbreviations: ADV = adenovirus; RSV = respiratory syncytial virus.
TextSentencer_T105 13504-13633 Sentence denotes The relationship between type of transplantation and risk of PC was particularly evident when only infectious PC were considered.
TextSentencer_T106 13634-13756 Sentence denotes Thus, pulmonary infections occurred in 27/79 (34%) of allo-HSCT patients and 9/96 (9%) of auto-HSCT recipients (Po 0.001).
TextSentencer_T107 13757-13876 Sentence denotes Duration of neutropenia (16 ± 5 vs 12 ± 4 days; P o 0.001) was also a risk factor associated with pulmonary infections.
TextSentencer_T108 13877-13886 Sentence denotes Table 5 .
TextSentencer_T109 13887-13960 Sentence denotes Thirty-two percent of all cause mortality was due to PC (12 of 38 cases).
TextSentencer_T110 13961-14027 Sentence denotes Most of the lethal PC were due to infections (9 of 12 cases, 75%).
TextSentencer_T111 14028-14150 Sentence denotes Remarkably, P. aeruginosa was the most commonly involved microorganism causing death (55% of lethal pulmonary infections).
TextSentencer_T112 14151-14273 Sentence denotes Six out of 13 (46%) cases of bacterial pneumonia died compared with 1 out of 14 cases of viral pneumonia (7%) (P = 0.026).
TextSentencer_T113 14274-14442 Sentence denotes Allo-HSCT, presence of PC, grade II-IV acute GVHD and duration of neutropenia were risk factors associated with overall mortality in the univariate analysis (Table 6 ).
TextSentencer_T114 14443-14569 Sentence denotes In the multivariate analysis, allo-transplantation and presence of PC were independent risk factors for mortality ( Table 6 ).
TextSentencer_T115 14570-14673 Sentence denotes The model to predict mortality was well calibrated with a P-value in the Hosmer-Lemeshow test of 0.075.
TextSentencer_T116 14674-14854 Sentence denotes The present study demonstrates that PCs are common after HSCT, involving almost 30% of the recipients, and are particularly prevalent over the first 6 months after transplantation.
TextSentencer_T117 14855-14935 Sentence denotes These PC are mostly infectious (68%) with an associated mortality of 18% (9/50).
TextSentencer_T118 14936-15025 Sentence denotes The relative frequencies of different PCs vary at different post-transplantation periods.
TextSentencer_T119 15026-15242 Sentence denotes 16, 25 In this sense, a potential strength of the present study is that by following up all the patients included in the cohort for 1 year, an accurate determination of the prevalence of the different PC can be made.
TextSentencer_T120 15243-15354 Sentence denotes Remarkably, viruses were the most common cause of pulmonary infections, representing 47% (19/40) of pneumonias.
TextSentencer_T121 15355-15512 Sentence denotes Of note, 26% of the episodes of viral pneumonia were mixed (both bacteria and viruses) confirming that co-infection is a common occurrence in these patients.
TextSentencer_T122 15513-15690 Sentence denotes 26 The associated mortality of viral pneumonias was 27, 28 However, the important role that viruses have in the genesis of PC reinforces the importance of prevention strategies.
TextSentencer_T123 15691-15810 Sentence denotes 29 As in other prospective studies, bacteria were involved in 45% of the identified pulmonary infections in our cohort.
TextSentencer_T124 15811-15897 Sentence denotes 19 Remarkably, P. aeruginosa infections represented 61% of total bacterial infections.
TextSentencer_T125 15898-16018 Sentence denotes This finding confirms the current predominance of Gram-negative rods over Gram-positive cocci observed by other authors.
TextSentencer_T126 16019-16177 Sentence denotes 30 Interestingly, fluoroquinolone resistance was frequent (36% of P. aeruginosa isolates) probably owing to the widespread use of fluoroquinolone prophylaxis.
TextSentencer_T127 16178-16276 Sentence denotes This is particularly important as the associated mortality of P. aeruginosa in our series was 45%.
TextSentencer_T128 16277-16454 Sentence denotes Therefore the implementation of prophylactic protocols should be periodically re-evaluated in HSCT recipients depending on the different resistance patterns of each institution.
TextSentencer_T129 16455-16578 Sentence denotes 2, 30 Probable aspergillosis was diagnosed in only four patients, accounting for 10% of the diagnosed pulmonary infections.
TextSentencer_T130 16579-16729 Sentence denotes The low incidence of aspergillosis is most likely the result of the intense surveillance and prophylactic programs designed to avoid these infections.
TextSentencer_T131 16730-16854 Sentence denotes 31 Diagnostic evaluation of PC The present study confirms that the majority of the PC can be etiologically identified (83%).
TextSentencer_T132 16855-17035 Sentence denotes 2 A significant proportion of these episodes (59%) were diagnosed with the implementation of different non-invasive tests thus avoiding the requirement of more invasive procedures.
TextSentencer_T133 17036-17217 Sentence denotes Remarkably, nasopharyngeal swab was a very useful diagnostic tool providing the diagnosis of viral pneumonia in 75% of cases, and in all of them the results were confirmed with BAL.
TextSentencer_T134 17218-17235 Sentence denotes 29 Azoulay et al.
TextSentencer_T135 17236-17364 Sentence denotes 17 confirmed the utility of noninvasive tests in critically ill hematology and oncology patients with acute respiratory failure.
TextSentencer_T136 17365-17427 Sentence denotes More controversial is the role of FOB in the management of PC.
TextSentencer_T137 17428-17588 Sentence denotes 9, 15, 32, 33 In our cohort, with pre-established criteria to perform FOB, the overall diagnostic yield was 67% and increased up to 78% in pulmonary infections.
TextSentencer_T138 17589-17683 Sentence denotes Overall, 28% of the episodes of pulmonary infection could only be diagnosed by this technique.
TextSentencer_T139 17684-17779 Sentence denotes In almost half of the cases, the information obtained caused a change in the empiric treatment.
TextSentencer_T140 17780-17941 Sentence denotes Interestingly, in cases with negative non-invasive tests, the diagnostic yield of FOB was 62% ( Figure 2 ) demonstrating its utility in this particular scenario.
TextSentencer_T141 17942-18126 Sentence denotes Even in those patients with positive non-invasive tests, but with an unsolved or unfavorable clinical course, FOB identified unsuspected microorganisms in 24% of the cases (Figure 2) .
TextSentencer_T142 18127-18330 Sentence denotes Early FOB proportioned a significant increase of isolated pathogens compared with late FOB and mortality in the former group was somewhat lower, although the difference was not statistically significant.
TextSentencer_T143 18331-18501 Sentence denotes Our group had already shown that one of the most critical factors influencing the yield of FOB is the time elapsed between the initiation of symptoms and FOB performance.
TextSentencer_T144 18502-18619 Sentence denotes 7, 34 Establishing an early diagnosis leads to changes in empirical treatment and probably, improvement in prognosis.
TextSentencer_T145 18620-18634 Sentence denotes Shannon et al.
TextSentencer_T146 18635-18791 Sentence denotes 33 highlighted the importance of early diagnosis demonstrating that the diagnostic yield of FOB wanes with the elapsed time following clinical presentation.
TextSentencer_T147 18792-18865 Sentence denotes As in other series, we did not observe remarkable side effects after FOB.
TextSentencer_T148 18866-19217 Sentence denotes 2, 9, 33 In this sense, the conclusive demonstration by Azoulay et al., 17 in a prospective randomized study showing that FOB does not increase the proportion of patients requiring mechanical ventilation, reinforce the safety of this procedure and should help reluctant physicians caring for these patients to implement this procedure in early stages.
TextSentencer_T149 19218-19404 Sentence denotes Although prospective information regarding the outcome of HSCT recipients is scarce, the overall mortality of 22% in our series fits with that obtained recently by Aguilar-Guisado et al.
TextSentencer_T150 19405-19432 Sentence denotes 19 in allo-HSCT recipients.
TextSentencer_T151 19433-19542 Sentence denotes As reported in other series, relapse of disease and chronic GVHD were the most important causes of mortality.
TextSentencer_T152 19543-19812 Sentence denotes 19, 35 Interestingly, suffering a PC, particularly one of infectious origin, was responsible for one-third of the overall mortality and was also an independent risk factor for mortality, stressing the importance of the proper clinical management of these complications.
TextSentencer_T153 19813-19996 Sentence denotes A limitation of the present study is that all patients were treated at a single centre and the sample size was relatively small, particularly for the evaluation of prognostic factors.
TextSentencer_T154 19997-20191 Sentence denotes However, the study includes every HSCT performed consecutively in the centre during a 1-year follow-up and data related to complications and clinical management have been obtained prospectively.
TextSentencer_T155 20192-20237 Sentence denotes In summary, PC in HSCT recipients are common.
TextSentencer_T156 20238-20389 Sentence denotes In our series, viral infection is the most frequent etiology; however mortality due to bacterial pneumonia, in particular P. aeruginosa is much higher.
TextSentencer_T157 20390-20445 Sentence denotes PC are responsible for one-third of all the fatalities.
TextSentencer_T158 20446-20646 Sentence denotes Although in this prospective study we have shown the utility of non-invasive tests and the potential role of FOB when the evolution is unfavorable, this must be confirmed in further controlled trials.