Emergency Department, Hospital Universitario Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain.
Health Research Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Eur J Clin Microbiol Infect Dis. 2017 Aug;36(8):1511-1517. doi: 10.1007/s10096-017-2960-5. Epub 2017 Mar 25.
The aims of our study were to determine the factors associated with developing haematological toxicity (HT) in patients taking linezolid (LZD), to develop a predictive model of HT in these patients, and to evaluate factors associated with 30-day mortality.
This was an observational retrospective cohort study of patients treated for at least 5 days with LDZ in 2015. Demographic, clinical and analytical data were collected. Development of HT was defined as a 25% platelet count decrease between the basal count and the 1-week lab test.
Five hundred forty-nine patients were finally included, mean age was 73.3 (SD 15.4) years, and 303 (55.2%) were men. One hundred seventy-five (30.1%) patients achieved HT criteria during treatment with LZD and 41 (7.5%) died. The final model included the presence of cerebrovascular disease (2 points), moderate or severe liver disease (2 points), renal failure (2 points) and basal platelet count less than 90,000/mm3 (8 points). This new model showed an AUC of 0.711 (IC 95% 0.664-0.757; p < 0.001) to predict the development of HT. The probability of HT based on this classification was 6.2, 29.9 and 76.5% for low (0-4 points), intermediate (5-10 points) and high risk (>10 points), respectively. The independent variables associated with 30-day mortality were metastatic solid tumor, lymphoma, age >75 years and HT.
This score could help in the identification of patients with high risk for HT and assess the use of an antibiotic other than LZD, an important issue considering its relation with 30-day mortality observed in our study.
本研究旨在确定接受利奈唑胺（LZD）治疗的患者发生血液学毒性（HT）的相关因素，为这些患者建立 HT 预测模型，并评估与 30 天死亡率相关的因素。
这是一项 2015 年对至少接受 5 天 LZD 治疗的患者进行的观察性回顾性队列研究。收集了人口统计学、临床和分析数据。HT 的发展定义为基础计数与第 1 周实验室检测之间血小板计数下降 25%。
最终纳入 549 例患者，平均年龄为 73.3（15.4）岁，303 例（55.2%）为男性。175 例（30.1%）患者在接受 LZD 治疗期间达到 HT 标准，41 例（7.5%）死亡。最终模型包括存在脑血管疾病（2 分）、中重度肝脏疾病（2 分）、肾衰竭（2 分）和基础血小板计数<90,000/mm3（8 分）。该新模型预测 HT 发生的 AUC 为 0.711（95%CI 0.664-0.757；p<0.001）。基于该分类，HT 发生的概率分别为低危（0-4 分）、中危（5-10 分）和高危（>10 分）患者为 6.2%、29.9%和 76.5%。与 30 天死亡率相关的独立变量为转移性实体瘤、淋巴瘤、年龄>75 岁和 HT。
该评分有助于识别 HT 高危患者，并评估是否使用 LZD 以外的抗生素，这是一个重要问题，因为考虑到我们研究中观察到的与 30 天死亡率的关系。
