Incidence and prognostic factors for pulmonary infection complications in elderly patients with acute myeloid leukemia.

OBJECTIVE

To investigate the incidence, risk factors, and prognostic effect of pulmonary infections in elderly patients with acute myeloid leukemia (AML), and to provide evidence for optimizing infection prevention and management as well as individualized treatment strategies.

METHODS

We retrospectively analyzed clinical data from 150 elderly AML patients diagnosed and treated at our hospital between March 2020 and October 2022. Their demographics, laboratory test results, treatment regimens, and follow-up records were collected and analyzed. Logistic regression was used to identify risk factors for pulmonary infections, while Kaplan-Meier survival analysis and Cox regression were employed to assess the effect of infections on survival. Time-dependent ROC curves were applied to evaluate the predictive performance of key laboratory indicators.

RESULTS

Among the 150 cases, the incidence of pulmonary infections was 42%. Logistic regression identified low hemoglobin (Hb < 110.5 g/L), elevated C-reactive protein (CRP ≥ 24.01 mg/L), elevated procalcitonin (PCT ≥ 0.255 ng/mL), low neutrophil count (NC < 0.475×10/L), and low platelet count (PLT < 84×10/L) as independent risk factors for pulmonary infections (all P < 0.05). Kaplan-Meier survival analysis revealed that the median survival of patients with pulmonary infections was significantly lower than that of the non-infected group (P < 0.001). Multivariate Cox regression analysis demonstrated that pulmonary infections were an independent prognostic factor for survival in elderly AML patients (HR = 1.469, P = 0.011). Time-dependent ROC analysis showed that CRP and PCT had the highest predictive efficacy for pulmonary infections, with AUCs of 0.739 and 0.845, respectively.

CONCLUSION

Pulmonary infections are common among elderly AML patients and significantly worsen their prognosis. Low Hb, high CRP and PCT, and low NC and PLT are critical risk factors for infection. Strengthening infection monitoring and initiating early intervention may improve patient survival outcomes.