Prognostic factors and scoring model of hematological malignancies patients with bloodstream infections
- 22 Downloads
Patients with hematological malignancies (HMs) are at a higher risk for bloodstream infections (BSIs), which pose significant burden on morbidity and mortality. Better risk stratification helps in medical decision making, increasing efficiency and reducing economic burden. The aim of this study was to develop and validate a reliable prediction model which can be used to identify HM patients at higher risk for BSIs.
We conducted a retrospective cohort study in three university-affiliated hospitals in Hunan Province, China, from January 2010 to April 2015. A total of 521 HMs patients with BSIs were finally included in this study and were divided into the derivation set and validation set. Survivors and non-survivors were compared to identify the predictors of 30-day mortality.
The multivariate analysis yielded the following significant mortality-related risk factors: age > 60 years (95% CI 1.047–5.474), relapsed or uncontrolled malignancy (95% CI 2.043–14.029), Pitt bacteremia score > 3 (95% CI 1.614–6.35), prolonged neutropenia (95% CI 1.181–5.824), use of vasopressors (95% CI 3.009–12.210), acute respiratory failure (95% CI 3.061–14.911), fungemia (95% CI 1.334–12.121), inadequate antibiotic treatment (95% CI 1.682–7.591), albumin < 30 g/L (95% CI 1.030–3.446), TBil > 34.2 µmol/L (95% CI 1.109–5.438). In both derivation and validation sets, our model showed reliable prediction value with areas under the receiver operating curve of 0.876 and 0.873.
The risk factors in this study have the ability to identify patients with HMs and BSIs at high risk for mortality. Our model provides an excellent foundation for predicting 30-day morality in HM patients suffering from BSI and helps target high-risk patients for management decision making.
KeywordsHematological malignancies Bloodstream infection Prognostic factors Scoring model
We thank all those who helped us in this study; in particular, the Department of Hematology and the Department of Clinical Laboratory for making this study possible. We thank Qing Yang for checking the English version of the manuscript and Di Zhang, Wei Cao, Qingxia Liu for providing patients to the study.
This work was supported by the Fundamental Research Funds for the Central Universities of Central South University No.2016zzts151 and No.2016zzts567, and the Education Reform Program for Central South University No. 2016JGB20.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest. All authors meet the ICMJE authorship criteria.
This retrospective chart review study was evaluated by the Ethics Committee of the Central South University and deemed exempt from a formal review as no personally identifiable information would be collected.
The requirement for informed consent from patients was also waived.
- 5.Attman E, Aittoniemi J, Sinisalo M, Vuento R, Lyytikainen O, Karki T, et al. Etiology, clinical course and outcome of healthcare-associated bloodstream infections in patients with hematological malignancies: a retrospective study of 350 patients in a Finnish tertiary care hospital. Leuk Lymphoma. 2015;56:3370–7.CrossRefPubMedGoogle Scholar
- 6.Trecarichi EM, Pagano L, Candoni A, Pastore D, Cattaneo C, Fanci R, et al. Current epidemiology and antimicrobial resistance data for bacterial bloodstream infections in patients with hematologic malignancies: an Italian multicentre prospective survey. Clin Microbiol Infect. 2015;21:337–43.CrossRefPubMedGoogle Scholar
- 13.Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: Summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 2013;98:1826–1835.Google Scholar
- 16.Kim SH, Kwon JC, Choi SM, Lee DG, Park SH, Choi JH, et al. Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum beta-lactamase production and its impact on outcome. Ann Hematol. 2013;92:533–41.CrossRefPubMedGoogle Scholar
- 19.Flowers CR, Seidenfeld J, Bow EJ, Karten C, Gleason C, Hawley DK, et al. Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013;31:794–810.CrossRefPubMedGoogle Scholar
- 20.Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A, Mayaux J, et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol. 2013;31:2810–8.CrossRefPubMedGoogle Scholar
- 21.Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.CrossRefPubMedGoogle Scholar
- 31.Trecarichi EM, Tumbarello M, Spanu T, Caira M, Fianchi L, Chiusolo P, et al. Incidence and clinical impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies. J Infect. 2009;58:299–307.CrossRefPubMedGoogle Scholar
- 33.Hu FP, Zhu DM, Wang F, Jiang XF, Sun ZY, Chen ZJ, et al. CHINET 2013 surveillance of bacterial resistance in china. Chin J Infect Chemother 2014;15:365–74.Google Scholar