Nørgaard M, Larsson H, Pedersen G, Schønheyder H C, Sørensen H T
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Clin Microbiol Infect. 2006 Mar;12(3):217-23. doi: 10.1111/j.1469-0691.2005.01298.x.
This study examined the association between type of haematological malignancy, risk of bacteraemia and risk of mortality, with emphasis on the impact of bacteraemia type on mortality. A population-based cohort design was used, and all patients aged > or = 15 years with an incident haematological malignancy who were living in North Jutland County, Denmark, during 1992-2002 were included in the study. Among 1666 patients with an incident haematological malignancy, 358 (21%) suffered an episode of bacteraemia during a median follow-up period of 1.1 years (quartile 0.2-3.4) from the date of cancer diagnosis (overall incidence rate of 96/1000 person-years). In comparison to Hodgkin's disease, adjusted incidence rate ratios (IRRs) were 23.3 (95% CI, 10.0-54.5) for acute myeloid leukaemia, 3.8 (95% CI, 1.5-9.3) for multiple myeloma, and 2.2 (95% CI, 0.9-5.1) for non-Hodgkin's lymphoma or chronic lymphatic leukaemia. Overall cumulative 30-day mortality was 32% (95% CI, 27-37), and 90-day mortality was 50% (95% CI, 44-55). In comparison with acute myeloid leukaemia, adjusted mortality rate ratios (MRRs) were close to 1.0 for other haematological malignancies. In comparison to bacteraemia caused by Gram-positive bacteria, adjusted MRRs were 1.0 (95% CI, 0.6-1.5) for Gram-negative bacteraemia, and 1.9 (95% CI, 1.1-3.3) for polymicrobial bacteraemia or fungaemia. Thus, the risk of bacteraemia varied greatly according to the type of malignancy, while mortality rates were similar for these diseases, although dependent on the type of bacteraemia. Polymicrobial bacteraemia or fungaemia was associated with higher mortality.
本研究调查了血液系统恶性肿瘤类型、菌血症风险和死亡率之间的关联，重点关注菌血症类型对死亡率的影响。采用基于人群的队列设计，纳入了1992年至2002年期间居住在丹麦北日德兰郡、年龄≥15岁且患有新发血液系统恶性肿瘤的所有患者。在1666例新发血液系统恶性肿瘤患者中，358例（21%）在自癌症诊断之日起的中位随访期1.1年（四分位数间距0.2 - 3.4年）内发生了菌血症事件（总体发病率为96/1000人年）。与霍奇金淋巴瘤相比，急性髓系白血病的校正发病率比（IRR）为23.3（95%可信区间，10.0 - 54.5），多发性骨髓瘤为3.8（95%可信区间，1.5 - 9.3），非霍奇金淋巴瘤或慢性淋巴细胞白血病为2.2（95%可信区间，0.9 - 5.1）。总体30天累积死亡率为32%（95%可信区间，27 - 37），90天死亡率为50%（95%可信区间，44 - 55）。与急性髓系白血病相比，其他血液系统恶性肿瘤的校正死亡率比（MRR）接近1.0。与革兰氏阳性菌引起的菌血症相比，革兰氏阴性菌血症的校正MRR为1.0（95%可信区间，0.6 - 1.5），多微生物菌血症或真菌血症为1.9（95%可信区间，1.1 - 3.3）。因此，菌血症风险因恶性肿瘤类型而异，而这些疾病的死亡率相似，尽管取决于菌血症类型。多微生物菌血症或真菌血症与较高的死亡率相关。
