Qi Jiaqian, Gu Chengyuan, Wang Weijuan, Xiang Mengqi, Chen Xiaochen, Fu Jianhong
National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
Front Oncol. 2021 Oct 28;11:753712. doi: 10.3389/fonc.2021.753712. eCollection 2021.
Among the growing number of patients with hematologic neoplasms hospitalized in the intensive care unit (ICU), the largest proportion of these patients are diagnosed with lymphoma. However, less attention has been paid in the past to identifying critically ill patients and assessing the prognosis of patients in ICU. Traditional critical care-related scores have shown limitations and inaccuracy in predicting mortality risk.
Patients diagnosed with diffuse large B-cell lymphoma (DLBCL) were searched for in the Marketplace for Information in Intensive Care Medicine III (MIMIC-III) database. We searched mortality within 28 days as the primary endpoint. Logistics regression was used to screen risk factors. A calibration curve was used for internal validation, and the ROC curve and AUC were used to compare the new model with traditional scores.
405 patients with DLBCL are enrolled in the project. Multivariate analysis shows the patients with the level of lactate dehydrogenase (LDH) > 327 U/L had an increased risk of 28-day mortality in ICU than others (OR = 13.04, p<0.01). Notably, length of ICU stay, LDH, creatinine, white blood cell counts, and APS III score are independent prognostic factors for patients with DLBCL in the ICU. Then, all these independent prognostic factors are selected into our prediction model. The new model has good accuracy (C-index=0.863) and a calibration curve, which improves clinical status concerning established ratings such as IPI, NCCN-IPI score, SOFA, APS III, and LODS. The results of a multicenter external validation including 124 DLBCL patients also showed that the new model was more accurate than all other models.
The elevated level of LDH indicates a poor prognosis of patients with DLBCL in the ICU. Our risk score with crossed validation based on the level of LDH shows a significant prognostic value and may be a valuable tool for assessing the critically ill as well.
在重症监护病房（ICU）住院的血液系统肿瘤患者数量不断增加，其中最大比例的患者被诊断为淋巴瘤。然而，过去在识别重症患者和评估ICU患者的预后方面关注较少。传统的重症监护相关评分在预测死亡风险方面存在局限性和不准确之处。
在重症监护医学信息市场III（MIMIC-III）数据库中搜索诊断为弥漫性大B细胞淋巴瘤（DLBCL）的患者。我们将28天内的死亡率作为主要终点进行搜索。采用逻辑回归筛选危险因素。使用校准曲线进行内部验证，并使用ROC曲线和AUC将新模型与传统评分进行比较。
该项目纳入了405例DLBCL患者。多因素分析显示，乳酸脱氢酶（LDH）水平>327 U/L的患者在ICU中28天死亡率的风险高于其他患者（OR = 13.04，p<0.01）。值得注意的是，ICU住院时间、LDH、肌酐、白细胞计数和APS III评分是ICU中DLBCL患者的独立预后因素。然后，将所有这些独立预后因素纳入我们的预测模型。新模型具有良好的准确性（C指数=0.863）和校准曲线，在预测患者的临床结局方面优于国际预后指数（IPI）、美国国立综合癌症网络IPI评分（NCCN-IPI）、序贯器官衰竭评估（SOFA）、急性生理学及慢性健康状况评分系统III（APS III）和逻辑器官功能障碍评分（LODS）等既定评分。包括124例DLBCL患者的多中心外部验证结果也表明，新模型比所有其他模型更准确。
LDH水平升高表明ICU中DLBCL患者的预后不良。我们基于LDH水平的交叉验证风险评分显示出显著的预后价值，也可能是评估重症患者的有价值工具。
