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Clinical diagnostic accuracy of respiratory failure in critically ill hematopoietic stem cell transplant patients

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Abstract

Rationale

Acute respiratory failure (ARF) is a frequent complication following hematopoietic cell transplantation (HCT). We aimed to characterize the etiologies of ARF in patients who died in the intensive care unit following HCT based on autopsy findings. We then evaluated agreement between the clinical and pathologic diagnosis.

Methods

We performed a chart review of all HCT patients who died and underwent autopsy in our ICU between 2006–2016. We evaluated the presumed clinical diagnosis and confidence in the diagnosis by chart review, the pathologic diagnosis on autopsy, and whether the clinical-pathologic diagnoses were concordant. When there was discordance, we evaluated whether knowledge of the pathology could have changed management.

Results

Thirteen patients underwent autopsy after dying. Infection was the presumed cause in 11/13 cases. The clinical and pathologic diagnoses were concordant in 6/13(46%). In the seven discordant cases (all clinically diagnosed as infection), autopsy revealed two non-infectious inflammatory causes, one post-transplant lymphoproliferative disorder, and three non-bacterial infectious etiology. Pathologic findings may have changed management in 7/13(54%) cases.

Conclusions

In a subset of HCT-recipients who died from respiratory failure, discordance was frequent between clinical and pathologic diagnoses. The risks and benefits of obtaining tissue to improve our diagnostic accuracy requires further evaluation.

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Author notes

  1. Reeta Barua and Bruno Ferreyro have contributed equally to the work.

Authors and Affiliations

  1. Division of Medical Oncology, University of Toronto, Toronto, Canada

    Reeta Barua

  2. Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Mount Sinai Hospital, 600 University Avenue, 18-206, Toronto, ON, M5G 1X5, Canada

    Bruno Ferreyro, Michael Detsky & Laveena Munshi

  3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Bruno Ferreyro & Laveena Munshi

  4. Division of Medical Oncology/Malignant Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada

    Santhosh Thyagu & Arjun Law

Authors
  1. Reeta Barua
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  2. Bruno Ferreyro
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  3. Michael Detsky
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  4. Santhosh Thyagu
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  5. Arjun Law
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  6. Laveena Munshi
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Correspondence to Laveena Munshi.

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Barua, R., Ferreyro, B., Detsky, M. et al. Clinical diagnostic accuracy of respiratory failure in critically ill hematopoietic stem cell transplant patients. Int J Hematol 116, 929–936 (2022). https://doi.org/10.1007/s12185-022-03429-2

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  • DOI: https://doi.org/10.1007/s12185-022-03429-2

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