Sullivan L R, Sekeres M A, Shrestha N K, Maciejewski J P, Tiu R V, Butler R, Mossad S B
Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Transpl Infect Dis. 2013 Dec;15(6):652-7. doi: 10.1111/tid.12130. Epub 2013 Sep 9.
We conducted a case-control study to describe the epidemiology and risk factors for infections requiring hospitalization in patients with myelodysplastic syndromes (MDS). Of 497 patients identified, 103 patients developed 201 episodes of infection. The probability of acquiring an infection 1 year from date of MDS diagnosis was 15% (95% confidence interval [CI] 12-18%). Patients developing infections had decreased survival compared to those who did not (P = 0.007). Significant risk factors for infection were higher risk MDS (hazard ratio [HR] = 2.7, 95% CI = 1.7-4.1, P < 0.0001), nadir absolute neutrophil count <500/mL (HR = 1.8, 95% CI = 1.2-2.7, P < 0.007), chronic obstructive pulmonary disease (HR = 2.6, 95% CI = 1.4-4.9, P < 0.003), history of other malignancy (HR 2.0, 95% CI = 1.3-3.1, P < 0.003), and autoimmune disease (HR 2.9, 95% CI = 1.4-6.0, P < 0.005). Age, nadir platelet count <20,000/mL, diabetes mellitus, and MDS treatment were not significant risk factors. Pneumonia was the most common infection, and bacteria the predominant pathogens.
我们开展了一项病例对照研究，以描述骨髓增生异常综合征（MDS）患者中需要住院治疗的感染的流行病学及危险因素。在确定的497例患者中，103例患者发生了201次感染。自MDS诊断之日起1年发生感染的概率为15%（95%置信区间[CI] 12 - 18%）。发生感染的患者与未发生感染的患者相比，生存率较低（P = 0.007）。感染的显著危险因素包括较高风险的MDS（风险比[HR] = 2.7，95% CI = 1.7 - 4.1，P < 0.0001）、最低绝对中性粒细胞计数<500/mL（HR = 1.8，95% CI = 1.2 - 2.7，P < 0.007）、慢性阻塞性肺疾病（HR = 2.6，95% CI = 1.4 - 4.9，P < 0.003）、其他恶性肿瘤病史（HR 2.0，95% CI = 1.3 - 3.1，P < 0.003）和自身免疫性疾病（HR 2.9，95% CI = 1.4 - 6.0，P < 0.005）。年龄、最低血小板计数<20,000/mL、糖尿病和MDS治疗不是显著的危险因素。肺炎是最常见的感染，细菌是主要病原体。
