Chen Y, Wang Y, Jiang Z H, Xu L P, Zhang X H, Chen H, Chen Y Y, Wang F R, Wang J Z, Han W, Zhang Y Y, Han T T, Tang F F, Mo X D, Sun Y Q, Yan C H, Liu K Y, Huan X J
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China.
Zhonghua Nei Ke Za Zhi. 2017 Nov 1;56(11):804-809. doi: 10.3760/cma.j.issn.0578-1426.2017.11.006.
To investigate the prognostic factors of late-onset severe pneumonia (LOSP) in patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). From January 2009 to December 2015, 68 patients with LOSP after allo-HSCT at Peking University Institute of Hematology were enrolled. In this retrospective study, univariate and multivariate analysis were used to evaluate the prognostic factors for LOSP after allo-HSCT. The median time from allo-HSCT to the development of LOSP was 213 (90-2 330) days. The overall survival rate was 42.6% (29/68). The median survival time from LOSP to death was 21 days. Early mortality was defined as death within 21 days after LOSP, as late death more than or equal to 21 days. The median oxygenation index was 199.15 (92.21-290.48) mmHg. LOSPs in thirty-two patients (36.8%) were caused by virus, bacteria, fungi or mixed pathogens. The median C-reactive protein (CRP) was 75.65 (0.94-451.00) mg/L. The median procalcitonin (PCT) was 0.66 (0.00-249.00) μg/L. The higher PCT value indicated an early higher mortality rate by the ROC curve (PCT: cut-off ≥0.94 μg/L). Furthermore, multivariate analysis suggested that PCT more than or equal to 0.94 μg/L was a risk factor for early death of LOSP (=5.77, 95% 1.66-20.11, =0.006). LOSP occurred later or equal to 213 days after allo-HSCT was also a risk factor of early death in LOSP (=4.74, 95% 1.33-16.89, =0.017). No previous history of chronic graft versus host disease (GVHD) (=4.50, 95% 1.58-12.83, =0.005) and LOSP later or equal to 213 days (=4.40, 95% 1.61-11.99, =0.004) were the risk factors of late death in LOSP. PCT more than or equal to 0.94 μg/L and LOSP later or equal to 213 days are the risk factors of early death in LOSP. No previous chronic GVHD and LOSP later or equal to 213 days are the risk factors of late death in LOSP.
探讨异基因造血干细胞移植（allo-HSCT）患者迟发性重症肺炎（LOSP）的预后因素。2009年1月至2015年12月，北京大学血液病研究所68例allo-HSCT术后发生LOSP的患者纳入研究。本回顾性研究采用单因素和多因素分析评估allo-HSCT术后LOSP的预后因素。从allo-HSCT至发生LOSP的中位时间为213（90-2 330）天。总生存率为42.6%（29/68）。从LOSP至死亡的中位生存时间为21天。早期死亡定义为LOSP后21天内死亡，晚期死亡定义为大于或等于21天死亡。中位氧合指数为199.15（92.21-290.48）mmHg。32例患者（36.8%）的LOSP由病毒、细菌、真菌或混合病原体引起。中位C反应蛋白（CRP）为75.65（0.94-451.00）mg/L。中位降钙素原（PCT）为0.66（0.00-249.00）μg/L。ROC曲线显示，PCT值越高，早期死亡率越高（PCT：临界值≥0.94μg/L）。此外，多因素分析提示，PCT≥0.94μg/L是LOSP早期死亡风险因素（=5.77，95% 1.66-20.11，=0.006）。allo-HSCT后LOSP发生时间≥213天也是LOSP早期死亡风险因素（=4.74，95% 1.33-16.89，=0.017）。既往无慢性移植物抗宿主病（GVHD）病史（=4.50，95% 1.58-12.83，=0.005）和LOSP发生时间≥213天（=4.40，95% 1.61-11.99，=0.004）是LOSP晚期死亡风险因素。PCT≥0.94μg/L和LOSP发生时间≥213天是LOSP早期死亡风险因素。既往无慢性GVHD病史和LOSP发生时间≥213天是LOSP晚期死亡风险因素。
