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营养风险指数与多发性骨髓瘤患者自体干细胞移植后 30 天内菌血症相关。

The nutrition risk index is associated with bacteremia within 30 days after autologous stem cell transplantation in patients with multiple myeloma.

机构信息

Department of Internal Medicine, Infectology Unit, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.

Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.

出版信息

Transpl Infect Dis. 2020 Aug;22(4):e13302. doi: 10.1111/tid.13302. Epub 2020 May 19.

Abstract

OBJECTIVES

To assess whether the nutrition risk index (NRI) is associated with the risk of bacteremia within the first days after autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM).

MATERIALS AND METHODS

Retrospective cohort study of adult patients with MM taken to ASCT at the Hospital Universitario San Ignacio (Bogotá, Colombia) between 2005 and 2019. The outcome of interest was the incidence of bacteremia at 30 days. Multivariate analysis was used to identify whether the NRI was associated with bacteremia, controlling by different confounding variables.

RESULTS

One hundred and twenty-four patients with a median age of 58.5 years (IQR: 54-64) were included. 47.1% were in stage ISS III. 36.0% had moderate or severe malnourishment (NRI < 97.5). 11.2% presented bacteremia in the first 30 days after transplantation. In the univariate analysis, the NRI < 97.5 was associated with bacteremia (OR: 1.88; 95% CI: 1.30-2.72, P = .001); however, this association was not significant in the multivariate analysis, unlike the presence of mucositis (OR: 11.59; 95% CI: 1.9-68.3, <0.01), one or more previous lines of therapy (OR: 12.0; 95% CI: 2.1-67.4; P < .01), and duration of aplasia (OR: 1.70; 95% CI: 1.2-2.4, P < .01).

CONCLUSIONS

Patients with moderate or severe malnourishment have a higher incidence of bacteremia in the 30 days post-ASCT in patients with MM. Additional risk factors associated with bacteremia include the presence of mucositis, one or more previous lines of therapy, and the duration of aplasia.

摘要

目的

评估营养风险指数(NRI)与多发性骨髓瘤(MM)患者自体干细胞移植(ASCT)后最初几天内菌血症风险的相关性。

材料与方法

对 2005 年至 2019 年期间在哥伦比亚波哥大圣伊西德罗大学医院接受 ASCT 的成年 MM 患者进行回顾性队列研究。主要结局为 30 天内菌血症的发生率。采用多变量分析来识别 NRI 是否与菌血症相关,同时控制了不同的混杂变量。

结果

共纳入 124 例中位年龄为 58.5 岁(IQR:54-64)的患者。47.1%的患者处于 ISS III 期。36.0%的患者存在中重度营养不良(NRI<97.5)。11.2%的患者在移植后 30 天内出现菌血症。在单变量分析中,NRI<97.5 与菌血症相关(OR:1.88;95%CI:1.30-2.72,P=0.001);然而,在多变量分析中,这种相关性并不显著,而黏膜炎的存在(OR:11.59;95%CI:1.9-68.3,<0.01)、一个或多个既往治疗线数(OR:12.0;95%CI:2.1-67.4;P<0.01)和再生障碍期持续时间(OR:1.70;95%CI:1.2-2.4,P<0.01)是与菌血症相关的其他危险因素。

结论

在 MM 患者 ASCT 后 30 天内,中重度营养不良的患者菌血症发生率较高。与菌血症相关的其他危险因素包括黏膜炎的存在、一个或多个既往治疗线数以及再生障碍期持续时间。

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