Qi J Q, You T, Wang H, Han W, Fan Y, Chen J, Wu D P, Han Y
The First Affiliated Hospital of Suzhou University, Jiangsu Institute of Hematology, National Center for Hematology and Clinical Research, Hematopoietic Stem Cell Transplantation Institute of Soochow University, Hematology Collaborative Innovation Center, Suzhou 215006, China.
Zhonghua Xue Ye Xue Za Zhi. 2022 Jun 14;43(6):481-487. doi: 10.3760/cma.j.issn.0253-2727.2022.06.007.
To study hematopoietic stem cell transplantation-related bleeding prognosis and construct a bleeding prediction model. The clinical data of 555 patients with malignant hematologic diseases who underwent allogeneic hematopoietic stem cell transplantation between May 1(st) 2004, and April 1(st) 2012 was analyzed retrospectively, and a prediction model was constructed. Of the 555 patients, a total of 302 (54.0% ) patients exhibited bleeding events of varying degrees, including 151 (27.0% ) with grade Ⅰ bleeding, 63 (11.0% ) with grade Ⅱ bleeding, 48 (9.0% ) with grade Ⅲ bleeding, and 40 (7.0% ) with grade Ⅳ bleeding. Multifactorial analysis showed that the overall mortality (=12.53, 95% 7.91-19.87, <0.001) and non-recurrence mortality (=23.79, 95% 12.23-46.26, <0.001) were higher in patients with higher bleeding grades (Ⅲ and Ⅳ bleeding) compared to those with lower bleeding grades. Additionally, the donor's underlying disease, graft-versus-host disease (GVHD) score, poor platelet reconstitution, and ineffective platelet transfusion were independently associated with bleeding risk. The bleeding model constructed using the above variables showed good accuracy (C-Index=0.934) , and its efficacy was significantly higher than previous bleeding models. Hematopoietic stem cell transplant patients are at increased risk of death after a bleeding event. The cross-validated bleeding risk prediction model is valuable for early intervention.
研究造血干细胞移植相关出血的预后并构建出血预测模型。回顾性分析了2004年5月1日至2012年4月1日期间接受异基因造血干细胞移植的555例恶性血液病患者的临床资料，并构建了预测模型。在这555例患者中，共有302例（54.0%）患者出现了不同程度的出血事件，其中Ⅰ级出血151例（27.0%），Ⅱ级出血63例（11.0%），Ⅲ级出血48例（9.0%），Ⅳ级出血40例（7.0%）。多因素分析显示，与出血分级较低的患者相比，出血分级较高（Ⅲ级和Ⅳ级出血）的患者总死亡率（=12.53，95% 7.91 - 19.87，<0.001）和非复发死亡率（=23.79，95% 12.23 - 46.26，<0.001）更高。此外，供者的基础疾病、移植物抗宿主病（GVHD）评分、血小板重建不良和血小板输注无效与出血风险独立相关。使用上述变量构建的出血模型显示出良好的准确性（C指数 = 0.934），其效能显著高于先前的出血模型。造血干细胞移植患者出血事件后死亡风险增加。经交叉验证的出血风险预测模型对早期干预具有重要价值。
