移植日C反应蛋白水平对预测异基因造血干细胞移植术后早期感染及预后的价值
[Value of C-reactive protein level on transplantation day in predicting early post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation].
作者信息
Shen Kefeng, Liu Qifa, Sun Jing, Jiang Qianli, Zhang Yu, Zhou Hongsheng, Dai Min, Xiao Min, Wang Jin, Luo Li, Li Qinlu, An Haiyun, Hong Zhen-Ya, Meng Li, Yang Mo, Zhou Jianfeng, Wang Gaoxiang
机构信息
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.E-mail:
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2015 Nov;35(11):1535-9.
OBJECTIVE
To investigate the value of C-reactive protein (CRP) on transplantation day in predicting early post-transplant infections and outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT).
METHODS
We retrospectively analyzed the clinical data of 78 recipients undergoing allo-HSCT. The clinical reference value of CRP on transplantation day was determined, and its sensitivity and specificity for diagnosing bacteremia was analyzed using receiver-operating characteristic curve (ROC). The incidence of transplant-related complications, overall survival, and relapse rate of the patients were analyzed with respect to the CRP level.
RESULTS
The clinical reference value of CRP for diagnosing bacteremia was 23.3 mg/L (AUC=0.735 [95% CI: 0.623-0.848], P=0.001), which had a diagnostic sensitivity and specificity of 0.793 and 0.592, respectively. Compared with the patients with low CRP levels, the patients with high CRP levels tended to have delayed neutrophil reconstitution and platelet engraftment by 0.71 days (P=0.237) and 4.09 days (P=0.048), respectively, and had a significantly higher incidence of bacteremia (17.1% vs 53.5%, P=0.001) and CMV viremia (37.1% vs 72.1%, P=0.003) within 100 days following the transplantation; the incidences of EBV viremia, pulmonary invasive fungal infection, or acute graft versus host disease (aGVHD) showed no significant difference between the two groups (41.9% vs 22.9%, P=0.094; 14.0% vs 5.7%, P=0.285; 51.2% vs 45.7, P=0.656, respectively). During the follow-up for a median of 318 (7-773) days in high-CRP group and for 299 (78-747) days in low-CRP group, the high-CRP group showed a significantly lower 2-year overall survival than the low-CRP group (42.5% vs 78.4%, P=0.022), and tended to have a higher 2-year cumulative relapse rate (52.3% vs 19.8%, P=0.235). Logistic multivariate analysis identified a high CRP level on transplantation day as the independent risk factor for post-transplant bacteremia within 100 days (OR=5.090 [95% CI: 1.115 -23.229], P=0.036).
CONCLUSION
A high CRP level on transplantation day can be indicative of a high risk of early post-transplant bacteremia and CMV viremia and also a poor prognosis following allo-HSCT.
目的
探讨移植日C反应蛋白（CRP）对异基因造血干细胞移植（allo-HSCT）后早期感染及预后的预测价值。
方法
回顾性分析78例接受allo-HSCT受者的临床资料。确定移植日CRP的临床参考值，采用受试者工作特征曲线（ROC）分析其诊断菌血症的敏感性和特异性。分析患者的移植相关并发症发生率、总生存率及复发率与CRP水平的关系。
结果
CRP诊断菌血症的临床参考值为23.3mg/L（AUC=0.735[95%CI：0.623-0.848]，P=0.001），诊断敏感性和特异性分别为0.793和0.592。与CRP水平低的患者相比，CRP水平高的患者中性粒细胞重建延迟0.71天（P=0.237），血小板植入延迟4.09天（P=0.048），移植后100天内菌血症（17.1%对53.5%，P=0.001）和CMV病毒血症（37.1%对72.1%，P=0.003）的发生率显著更高；两组EBV病毒血症、肺部侵袭性真菌感染或急性移植物抗宿主病（aGVHD）的发生率无显著差异（分别为41.9%对22.9%，P=0.094；14.0%对5.7%，P=0.285；51.2%对45.7，P=0.656）。高CRP组中位随访318（7-773）天，低CRP组中位随访299（78-747）天，高CRP组2年总生存率显著低于低CRP组（42.5%对78.4%，P=0.022），2年累积复发率有更高趋势（52.3%对19.8%，P=0.235）。Logistic多因素分析确定移植日CRP水平高是移植后100天内菌血症的独立危险因素（OR=5.090[95%CI：1.115-23.229]，P=0.036）。
结论
移植日CRP水平高提示移植后早期菌血症和CMV病毒血症风险高，且allo-HSCT预后差。
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