D 指数作为异基因造血干细胞移植患者血流感染的标志物。
D-index as a marker of bloodstream infections in patients with allogeneic hematopoietic stem cell transplantation.
机构信息
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Divison of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
出版信息
Transpl Infect Dis. 2021 Aug;23(4):e13588. doi: 10.1111/tid.13588. Epub 2021 Mar 1.
BACKGROUND
Neutropenia is a risk factor for development of infections; however, the direct effect of neutropenia on development of bloodstream infection (BSI) is not known. D-index, which is area between the neutrophil time curve and a neutrophil count of 0.5 × 10 /L, incorporates the combined effect of severity and duration of neutropenia. We aimed to evaluate whether D-index can be used as a marker for BSI in patients with allogeneic stem cell transplantation.
METHOD
We conducted a retrospective cohort study of patients undergoing allogeneic stem cell transplantation between January 1, 2005, and September 30, 2015. The primary outcome measure was the development of BSI within 30 days of transplantation.
RESULTS
A total of 714 patients were included in the study of whom 101 developed BSI. Patients with BSI had a significantly higher median D-index value compared with patients who did not have BSI (4990 vs. 3570, P < .001). As a marker, the performance of the D-index was similar to that of the duration of profound neutropenia (P = .18) and significantly better than the total duration of neutropenia (P = .001).
CONCLUSION
The D-index performed better than the total duration of neutropenia as a marker for BSI in patients with allogeneic stem cell transplantation. There was no difference between D-index and, a more easily calculable indicator, duration of profound neutropenia.
背景
中性粒细胞减少是发生感染的一个危险因素；然而，中性粒细胞减少对血流感染（BSI）发展的直接影响尚不清楚。D-指数是中性粒细胞时间曲线和中性粒细胞计数为 0.5×10 /L 之间的区域，综合了中性粒细胞减少的严重程度和持续时间的影响。我们旨在评估 D-指数是否可作为异基因干细胞移植患者发生 BSI 的标志物。
方法
我们进行了一项回顾性队列研究，纳入了 2005 年 1 月 1 日至 2015 年 9 月 30 日期间接受异基因干细胞移植的患者。主要结局指标是移植后 30 天内发生 BSI。
结果
共纳入 714 例患者，其中 101 例发生 BSI。与未发生 BSI 的患者相比，发生 BSI 的患者的 D-指数中位数明显更高（4990 与 3570，P<0.001）。作为一种标志物，D-指数的表现与重度中性粒细胞减少的持续时间相似（P=0.18），且明显优于中性粒细胞减少的总持续时间（P=0.001）。
结论
D-指数作为异基因干细胞移植患者 BSI 的标志物，其表现优于中性粒细胞减少的总持续时间。D-指数与更易于计算的重度中性粒细胞减少持续时间之间无差异。
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