Pal Khushboo V, Othus Megan, Ali Zahra, Russell Katherine, Shaw Carole, Percival Mary-Elizabeth M, Hendrie Paul C, Appelbaum Jacob S, Walter Roland B, Halpern Anna B
Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA.
Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA.
Blood Adv. 2024 Dec 24;8(24):6161-6170. doi: 10.1182/bloodadvances.2024014291.
Febrile neutropenia (FN) is the most common reason for hospital readmission after chemotherapy for acute myeloid leukemia (AML) and is a major driver of health care resource utilization. Although FN risk models exist, they have largely been developed and validated for solid tumors. We therefore examined whether baseline characteristics could predict which patients with AML and FN have a lower risk of progression to severe illness. We identified adults with high-grade myeloid neoplasms (≥10% blasts in the blood/marrow) who received intensive chemotherapy and who were admitted for FN between 2016 and 2023. We collected baseline clinical and disease variables. Outcomes were: infections identified, hospital length of stay (LOS), intensive care unit (ICU) admission, and survival. A lower-risk (LR) outcome was defined as LOS <72 hours without ICU admission or inpatient death. Univariate and multivariable (MV) logistic regression models were used to assess covariate associations with outcomes. We identified 397 FN admissions in 248 patients (median age, 61; [range, 29-77] years). The median hospital LOS was 6 days (range, 1-56) days; 10% required ICU admission, and 3.5% died inpatient. Only 15% of admissions were LR. Infection was identified in 59% of admissions. Physiologic parameters, including heart rate, blood pressure, and fever height, were the best predictors of LR admission and infection. We developed MV models to predict LR admission and infection with area under the curve (AUC) of 0.82 and 0.72, respectively. Established FN and critical illness models were not predictive of outcomes in AML, and we could not identify a LR group; thus, an AML-specific FN risk model requires further development and validation.
发热性中性粒细胞减少症（FN）是急性髓系白血病（AML）化疗后再次入院的最常见原因，也是医疗资源利用的主要驱动因素。尽管存在FN风险模型，但它们大多是针对实体瘤开发和验证的。因此，我们研究了基线特征是否可以预测哪些AML和FN患者进展为重症的风险较低。我们纳入了2016年至2023年间接受强化化疗且因FN入院的高级别髓系肿瘤（血液/骨髓中原始细胞≥10%）成人患者。我们收集了基线临床和疾病变量。结局指标包括：确诊的感染、住院时间（LOS）、重症监护病房（ICU）入院情况和生存率。低风险（LR）结局定义为LOS<72小时且未入住ICU或未发生住院死亡。采用单变量和多变量（MV）逻辑回归模型评估协变量与结局的关联。我们确定了248例患者的397次FN入院（中位年龄61岁；[范围29 - 77]岁）。中位住院LOS为6天（范围1 - 56天）；10%的患者需要入住ICU，3.5%的患者住院期间死亡。只有15%的入院患者属于LR。59%的入院患者确诊感染。生理参数，包括心率、血压和发热程度，是LR入院和感染的最佳预测指标。我们开发了MV模型来预测LR入院和感染，曲线下面积（AUC）分别为0.82和0.72。已有的FN和危重症模型不能预测AML的结局，且我们无法识别出LR组；因此，需要进一步开发和验证AML特异性的FN风险模型。
