白蛋白和C反应蛋白对异基因造血干细胞移植后嗜麦芽窄食单胞菌血症进展为肺炎及预后不良的预测意义。
Predictive implications of albumin and C-reactive protein for progression to pneumonia and poor prognosis in Stenotrophomonas maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation.
作者信息
Harada Kaito, Sekiya Noritaka, Konishi Tatsuya, Nagata Akihito, Yamada Yuta, Takezaki Toshiaki, Kaito Satoshi, Kurosawa Shuhei, Sakaguchi Masahiro, Yasuda Shunichiro, Sasaki Shugo, Yoshioka Kosuke, Watakabe-Inamoto Kyoko, Igarashi Aiko, Najima Yuho, Hagino Takeshi, Muto Hideharu, Kobayashi Takeshi, Doki Noriko, Kakihana Kazuhiko, Sakamaki Hisashi, Ohashi Kazuteru
机构信息
Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Department of Infection Prevention and Control, and Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 1138677, Japan.
出版信息
BMC Infect Dis. 2017 Sep 22;17(1):638. doi: 10.1186/s12879-017-2745-6.
BACKGROUND
Stenotrophomonas maltophilia (S. maltophilia) bacteremia causes significant morbidity and mortality in immunocompromised hosts. However, incidence and risk factors for mortality in S. maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain controversial. The primary aim of this study is to clarify factors associated with poor prognosis of allo-HSCT recipients with S. maltophilia bacteremia.
METHODS
From January 2005 to December 2014, patients with hematological diseases and S. maltophilia bacteremia at a single transplantation center in Japan were examined for incidence and 90-day mortality. Prognostic factors associated with 90-day mortality among allo-HSCT recipients were analyzed by log-rank test, and significant variables in the univariate analysis were included in the multivariate Cox proportional-hazards regression model.
RESULTS
A total of 65 patients, including 47 patients undergoing allo-HSCT, developed S. maltophilia bacteremia. The incidence of S. maltophilia bacteremia was significantly higher in allo-HSCT recipients compared to patients not receiving allo-HSCT (6.53 vs. 0.36 per 100 admissions, respectively; p < 0.01). The overall 90-day mortality in allo-HSCT recipients was 43%. Independent risk factors for 90-day mortality were low serum albumin (<3.0 g/dl) (HR = 10.86; 95% CI, 3.27-36.12) and high serum C-reactive protein (CRP) (≥10.0 mg/dl) (HR = 3.28; 95% CI, 1.00-10.72). Among 9 patients with both high CRP and low albumin, 5 had pneumonia at the onset of bacteremia and the remaining 4 patients developed pneumonia in a median of 3 days (range, 1 to 8 days) even under effective treatment. All 9 patients eventually died in a median of 2 days (range, 2 to 32 days). The probabilities of developing pneumonia in patients with or without high CRP and low albumin levels were 100% (9/9) and 10.5% (4/38), respectively (p < 0.01).
CONCLUSIONS
Allo-HSCT recipients had higher rates of S. maltophilia bacteremia than did patients not receiving allo-HSCT. High serum CRP and low serum albumin at the onset of bacteremia are predictive of disease progression to pneumonia and poor prognosis.
背景
嗜麦芽窄食单胞菌血症在免疫功能低下宿主中可导致显著的发病率和死亡率。然而，异基因造血干细胞移植（allo-HSCT）后嗜麦芽窄食单胞菌血症的发病率及死亡风险因素仍存在争议。本研究的主要目的是阐明allo-HSCT受者发生嗜麦芽窄食单胞菌血症预后不良的相关因素。
方法
对2005年1月至2014年12月间日本一家移植中心患有血液系统疾病且发生嗜麦芽窄食单胞菌血症的患者进行发病率及90天死亡率调查。通过对数秩检验分析allo-HSCT受者中与90天死亡率相关的预后因素，并将单因素分析中的显著变量纳入多因素Cox比例风险回归模型。
结果
共有65例患者发生嗜麦芽窄食单胞菌血症，其中47例为接受allo-HSCT者。allo-HSCT受者嗜麦芽窄食单胞菌血症的发病率显著高于未接受allo-HSCT的患者（分别为每100次入院6.53例和0.36例；p<0.01）。allo-HSCT受者的总体90天死亡率为43%。90天死亡率的独立危险因素为血清白蛋白低（<3.0g/dl）（HR=10.86；95%CI，3.27-36.12）和血清C反应蛋白（CRP）高（≥10.0mg/dl）（HR=3.28；95%CI，1.00-10.72）。在9例CRP高且白蛋白低的患者中，5例在菌血症发作时患有肺炎，其余4例即使在有效治疗下也在中位3天（范围1至8天）内发生肺炎。所有9例患者最终均在中位2天（范围2至32天）内死亡。CRP高和白蛋白低的患者发生肺炎的概率分别为100%（9/9）和10.5%（4/38）（p<0.01）。
结论
allo-HSCT受者嗜麦芽窄食单胞菌血症的发生率高于未接受allo-HSCT的患者。菌血症发作时血清CRP高和血清白蛋白低可预测疾病进展为肺炎及预后不良。
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