Yang Yali, Li Junjie, Huang Shifeng, Li Junnan, Yang Shuangshuang
Department of Laboratory Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, People's Republic of China.
Infect Drug Resist. 2023 Jun 8;16:3659-3669. doi: 10.2147/IDR.S404927. eCollection 2023.
This study aimed to assess the effect of infection patterns on the outcomes of patients with hematological malignancies (HM) and to identify the determinants of in-hospital mortality.
A case-control study was retrospectively conducted in a tertiary teaching hospital in Chongqing, Southwest China from 2011 to 2020. Clinical characteristics, microbial findings, and outcomes of HM patients with infections were retrieved from the hospital information system. Chi-square or Fisher's exact test was adopted to test the significance of mortality rate. Kaplan-Meier survival analysis and Log rank test were applied to evaluate and compare the 30-day survival rates of those groups. Binary logistic regression, Cox proportional hazards regression, and receiver operating characteristic curves were used to investigate the determinants of in-hospital mortality.
Of 1,570 enrolled participants, 43.63% suffered from acute myeloid leukemia, 69.62% received chemotherapy, and 25.73% had hematopoietic stem cell transplantation (HSCT). Microbial infection was documented in 83.38% of participants. Co-infection and septic shock were reported in 32.87% and 5.67% of participants, respectively. Patients with septic shock suffered a significantly lower 30-day survival rate, while those with distinct types of pathogens or co-infections had a comparable 30-day survival rate. The all-cause in-hospital mortality was 7.01% and higher mortality rate was observed in patients with allo-HSCT (7.20%), co-infection (9.88%), and septic shock (33.71%). Cox proportional hazards regression illustrated that elderly age, septic shock, and elevated procalcitonin (PCT) were independent predictors of in-hospital mortality. A PCT cut-off value of 0.24 ng/mL predicted in-hospital mortality with a sensitivity of 77.45% and a specificity of 59.80% (95% CI = 0.684-0.779, <0.0001).
Distinct infectious patterns of HM inpatients were previously unreported in Southwest China. It was the severity of infection, not co-infection, source of infection, or type of causative pathogen that positively related to poor outcome. PCT guided early recognition and treatment of septic shock were advocated.
本研究旨在评估感染模式对血液系统恶性肿瘤（HM）患者预后的影响，并确定院内死亡的决定因素。
2011年至2020年在中国西南部重庆的一家三级教学医院进行了一项回顾性病例对照研究。从医院信息系统中检索感染HM患者的临床特征、微生物学检查结果和预后情况。采用卡方检验或Fisher精确检验来检验死亡率的显著性。应用Kaplan-Meier生存分析和Log秩检验来评估和比较这些组的30天生存率。采用二元逻辑回归、Cox比例风险回归和受试者工作特征曲线来研究院内死亡的决定因素。
在1570名纳入的参与者中，43.63%患有急性髓系白血病，69.62%接受了化疗，25.73%进行了造血干细胞移植（HSCT）。83.38%的参与者有微生物感染记录。分别有32.87%和5.67%的参与者报告有合并感染和感染性休克。感染性休克患者的30天生存率显著较低，而不同病原体类型或合并感染的患者30天生存率相当。全因院内死亡率为7.01%，异基因HSCT患者（7.20%）、合并感染患者（9.88%）和感染性休克患者（33.71%）的死亡率较高。Cox比例风险回归表明，老年、感染性休克和降钙素原（PCT）升高是院内死亡的独立预测因素。PCT临界值为0.24 ng/mL时预测院内死亡的敏感性为77.45%，特异性为59.80%（95%CI = 0.684 - 0.779，<0.0001）。
中国西南部此前未报道过HM住院患者不同的感染模式。与不良预后呈正相关的是感染的严重程度，而非合并感染、感染源或致病病原体类型。提倡PCT指导感染性休克的早期识别和治疗。
