Association between adenovirus infection and mortality outcome among pediatric patients after hematopoietic stem cell transplant

Abstract

Background: Adenovirus can cause severe diseases in post-hematopoietic stem cell transplant (HSCT) patients. Because these patients also have many other factors contributing to mortality, it remains controversial whether adenovirus infection itself contributes to increased mortality in these patients. Objective: To determine if adenovirus infection contributes to mortality in pediatric post-HSCT patients. Methods: This retrospective cohort study was performed in post HSCT patients, aged 0–18 years old, admitted at Ramathibodi Hospital from 2016 to 2020. Adenovirus infection was defined as the detection of adenovirus in blood or urine by polymerase chain reaction. Multivariate cox regression was used to identify factors associated with death. Results: The incidence of overall adenovirus infection (viremia or viruria) in this cohort was 20.8% (26 out of 125 enrolled patients). From the multivariate cox regression analysis, overall adenovirus infection was not significantly associated with death (hazard ratio [HR]: 2.41; 95% confidence interval [CI]: 0.96–6.06; p =.060). However, presence of viremia (HR: 3.90; 95% CI: 1.40–10.86; p =.009), having maximal serum viral load > 10 000 copies/ml (HR: 3.70; 95% CI: 1.20–11.38; p =.023), presence of end-organ diseases (HR: 3.44; 95% CI: 1.18–10.01; p =.023) were associated with mortality. Underlying diseases requiring long-term immunosuppressive drugs before HSCT, invasive fungal disease, invasive bacterial infection, cytomegalovirus infection, and longer engraftment time were also associated with mortality. Conclusion: Overall adenovirus infection does not appear to play a significant role in mortality in pediatric post-HSCT patients. However, more invasive forms of adenovirus infection were associated with mortality in these patients.