急性髓系白血病患者的发热性中性粒细胞减少症：qSOFA 评分、C 反应蛋白和血培养结果与预后的关系。
Febrile neutropenia in patients with acute myeloid leukemia: Outcome in relation to qSOFA score, C-reactive protein, and blood culture findings.
机构信息
Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
Institute of Clinical Medicine/Internal Medicine, Faculty of Medicine, University of Eastern Finland, Kuopio, Finland.
出版信息
Eur J Haematol. 2020 Dec;105(6):731-740. doi: 10.1111/ejh.13500. Epub 2020 Sep 28.
OBJECTIVES
To evaluate quick Sequential Organ Failure Assessment (qSOFA) score during febrile neutropenia (FN) in adult patients receiving intensive chemotherapy for acute myeloid leukemia (AML).
METHODS
qSOFA score, as well as the association of qSOFA score with ICU admission, infectious mortality, blood culture findings, and C-reactive protein (CRP) measurements during FN were assessed among 125 adult AML patients with 355 FN periods receiving intensive chemotherapy in a tertiary care hospital from November 2006 to December 2018.
RESULTS
The multivariate model for qSOFA score ≥ 2 included CRP ≥ 150 mg/L on d0-2 [OR 2.9 (95% CI 1.1-7.3), P = .026], Gram-negative bacteremia [OR 2.7 (95% CI 1.1-6.9), P = .034], and treatment according to AML-2003 vs more recent protocols [OR 2.7 (95% CI 1.0-7.4), P = .047]. Age or gender did not gain significance in the model. qSOFA score ≥ 2 was associated with ICU treatment and infectious mortality during FN with sensitivity and specificity of 0.700 and 0.979, and 1.000 and 0.971, respectively.
CONCLUSION
qSOFA offers a useful tool to evaluate the risk of serious complications in AML patients during FN.
目的
评估接受强化化疗的急性髓系白血病（AML）成人患者中性粒细胞减少伴发热期间的快速序贯器官衰竭评估（qSOFA）评分。
方法
评估了 2006 年 11 月至 2018 年 12 月在一家三级护理医院接受强化化疗的 125 例 AML 成人患者 355 例 FN 期间的 qSOFA 评分，以及 qSOFA 评分与 ICU 收治、感染性死亡率、血培养结果和 FN 期间 C 反应蛋白（CRP）测量之间的关系。
结果
qSOFA 评分≥2 的多变量模型包括 d0-2 时 CRP≥150mg/L[OR 2.9（95%CI 1.1-7.3），P=0.026]、革兰氏阴性菌血症[OR 2.7（95%CI 1.1-6.9），P=0.034]和根据 AML-2003 与更新的方案治疗[OR 2.7（95%CI 1.0-7.4），P=0.047]。年龄或性别在模型中没有获得显著性。qSOFA 评分≥2 与 FN 期间 ICU 治疗和感染性死亡率相关，其敏感性和特异性分别为 0.700 和 0.979，以及 1.000 和 0.971。
结论
qSOFA 为评估 AML 患者 FN 期间严重并发症风险提供了有用的工具。
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