Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy.
Unit of Hematology, ASL TO4, Ivrea, Turin, Italy.
Eur J Haematol. 2023 Jun;110(6):696-705. doi: 10.1111/ejh.13952. Epub 2023 Mar 24.
Chemotherapy-induced neutropenia in acute myeloid leukaemia (AML) is a risk factor for life-threatening infections. Early diagnosis and prompt interventions are associated with better outcomes, but the prediction of infection severity remains an open question. Recently, National Early Warning Score (NEWS) and quick sequential organ failure assessment (qSOFA) scores were proposed as warning clinical instruments predicting in-hospital mortality, but their role in the haematological context is still unknown.
We retrospectively assess the predictive role of NEWS and qSOFA in a large and homogeneous cohort of adult AML patients treated with intensive chemotherapy. In a total of 1048 neutropenic episodes recorded in 334 consecutive patients, the scores were applied to predict outcomes on the same day of fever onset, and after 24 and 48 h from score calculation.
Both NEWS and qSOFA significantly predicted death, with more accuracy on the same day (NEWS AUROC 0.984 and qSOFA AUROC 0.969) and after 24 h (NEWS AUROC 0.928 and qSOFA AUROC 0.887), while remained moderately accurate after 48 h. Furthermore, also ICU admission was accurately predicted at fever onset and after 24 h.
Both scores were useful tools in the management of post chemotherapy neutropenic febrile AML patients.
急性髓系白血病（AML）化疗引起的中性粒细胞减少是发生威胁生命感染的危险因素。早期诊断和及时干预与更好的结果相关，但感染严重程度的预测仍是一个悬而未决的问题。最近，国家早期预警评分（NEWS）和快速序贯器官衰竭评估（qSOFA）评分被提出作为预测住院死亡率的预警临床工具，但它们在血液学背景下的作用仍不清楚。
我们回顾性评估了 NEWS 和 qSOFA 在接受强化化疗的大量和同质的成年 AML 患者中性粒细胞减少症患者中的预测作用。在 334 例连续患者中记录的 1048 例中性粒细胞减少症发作中，应用这些评分来预测发热当天、评分后 24 小时和 48 小时的结局。
NEWS 和 qSOFA 均显著预测死亡，当天的准确性更高（NEWS AUC 为 0.984，qSOFA AUC 为 0.969），24 小时后（NEWS AUC 为 0.928，qSOFA AUC 为 0.887）的准确性更高，而 48 小时后仍保持中等准确性。此外，在发热时和 24 小时后也能准确预测 ICU 入院。
这两个评分在化疗后中性粒细胞减少性发热 AML 患者的管理中都是有用的工具。
