Post-Transplant and In-Hospital Risk Factors for ARDS After Hematopoietic Stem Cell Transplantation

Svetlana Herasevich, Ryan D. Frank, William J. Hogan, Hassan Alkhateeb, Andrew H. Limper, Ognjen Gajic, Hemang Yadav

Research output: Contribution to journalArticlepeer-review


BACKGROUND: ARDS is a serious complication of hematopoietic stem cell transplant (HSCT). Pre-transplant risk factors for developing ARDS after HSCT have been recently identified. The objective of this study was to better understand post-transplant risk factors for developing ARDS after HSCT. METHODS: This was a nested case-control study. ARDS cases were matched to hospitalized non-ARDS controls by age, type of transplantation (allogeneic vs autologous), and time from transplantation. In a conditional logistic regression model, any potential risk factors were adjusted a priori for risk factors known to be associated with ARDS development. RESULTS: One hundred and seventy ARDS cases were matched 1:1 to non-ARDS hospitalized controls. Pre-admission, cases were more likely to be on steroids (odds ratio [OR] 1.90 [1.13– 3.19], P =.02). At time of admission, cases had lower platelet count (OR 0.95 [0.91–0.99], P =.02), lower bicarbonate (OR 0.94 [0.88–0.99], P =.035), and higher creatinine (OR 1.91 [1.23– 2.94], P =.004). During the first 24 h after admission, cases were more likely to have received transfusion (OR 2.41 [1.48–3.94], P <.001), opioids (OR 2.94 [1.67–5.18], P <.001), and have greater fluid administration (OR 1.52 [1.30–1.78], P <.001). During the hospitalization, ARDS cases had higher temperature (OR 1.77 [1.34–2.33], P <.001) and higher breathing frequency (OR 1.52 [1.33–1.74], P <.001). ARDS cases were more likely to have had sepsis (OR 68.0 [15.2– 301.7], P <.001), bloodstream infection (OR 4.59 [2.46–8.57], P <.001), and pneumonia (OR 9.76 [5.01–19.00], P <.001). CONCLUSIONS: Several post-transplant predictors of ARDS development specific to the HSCT population were identified in the pre-hospital and early in-hospital domains. These findings can provide insights into causal mechanisms of ARDS development and be used to develop HSCT-specific risk prediction models.

Original languageEnglish (US)
Pages (from-to)77-86
Number of pages10
JournalRespiratory care
Issue number1
StatePublished - Jan 1 2023


  • ICU
  • bone marrow trans plant
  • hematopoietic stem cell transplantation
  • immunocompromised host
  • respiratory failure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Pulmonary and Respiratory Medicine


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