Skip to main content

Advertisement

SpringerLink
Log in

Prognostic factors and scoring model of hematological malignancies patients with bloodstream infections

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Norgaard M, Larsson H, Pedersen G, Schonheyder HC, Sorensen HT. Risk of bacteraemia and mortality in patients with haematological malignancies. Clin Microbiol Infect. 2006;12:217–23.

    Article  PubMed  CAS  Google Scholar 

  2. Tumbarello M, Spanu T, Caira M, Trecarichi EM, Laurenti L, Montuori E, et al. Factors associated with mortality in bacteremic patients with hematologic malignancies. Diagn Microbiol Infect Dis. 2009;64:320–6.

    Article  PubMed  Google Scholar 

  3. Madani TA. Clinical infections and bloodstream isolates associated with fever in patients undergoing chemotherapy for acute myeloid leukemia. Infection. 2000;28:367–73.

    Article  PubMed  CAS  Google Scholar 

  4. Chen CY, Tsay W, Tang JL, Tien HF, Chen YC, Chang SC, et al. Epidemiology of bloodstream infections in patients with haematological malignancies with and without neutropenia. Epidemiol Infect. 2010;138:1044–51.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google 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.

    Article  PubMed  CAS  Google Scholar 

  7. Klastersky J. Current attitudes for therapy of febrile neutropenia with consideration to cost-effectiveness. Curr Opin Oncol. 1998;10:284–90.

    Article  PubMed  CAS  Google Scholar 

  8. Kaye KS, Marchaim D, Chen TY, Chopra T, Anderson DJ, Choi Y, et al. Predictors of nosocomial bloodstream infections in older adults. J Am Geriatr Soc. 2011;59:622–7.

    Article  PubMed  Google Scholar 

  9. Perez-Garcia A, Landecho MF, Beunza JJ, Conde-Estevez D, Horcajada JP, Grau S, et al. Enterococcal bloodstream infection. Design and validation of a mortality prediction rule. Int J Clin Pract. 2016;70:147–55.

    Article  PubMed  CAS  Google Scholar 

  10. Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Predictive scoring model of mortality in gram-negative bloodstream infection. Clin Microbiol Infect. 2013;19:948–54.

    Article  PubMed  CAS  Google Scholar 

  11. Tumbarello M, Trecarichi EM, Caira M, Candoni A, Pastore D, Cattaneo C, et al. Derivation and validation of a scoring system to identify patients with bacteremia and hematological malignancies at higher risk for mortality. PLoS One. 2012;7:e51612.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. de Naurois J, Novitzky-Basso I, Gill MJ, Marti FM, Cullen MH, Roila F. Management of febrile neutropenia: ESMO clinical practice guidelines. Ann Oncol. 2010;21:v252–v256.

    Article  Google 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 

  14. Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev. 2006;19:788–802.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Russell JA. Management of sepsis. N Engl J Med. 2006;355:1699–713.

    Article  PubMed  CAS  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.

    Article  PubMed  CAS  Google Scholar 

  17. Liu J, Cheng Q, Yang Q, Li X, Shen X, Zhang L, et al. Prognosis-related factors in intensive care unit (ICU) patients with hematological malignancies: a retrospective cohort analysis in a Chinese population. Hematology. 2015;20:494–503.

    Article  PubMed  Google Scholar 

  18. Chow JW, Yu VL. Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents. 1999;11:7–12.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  CAS  Google Scholar 

  22. Marin M, Gudiol C, Ardanuy C, Garcia-Vidal C, Jimenez L, Domingo-Domenech E, et al. Factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection. Clin Microbiol Infect. 2015;21:583–90.

    Article  PubMed  CAS  Google Scholar 

  23. Agrawal GN, Shevade SU. Comparison of Clinical and Laboratory Standards Institute 2008 and 2010 guidelines in interpreting susceptibility of enterobacteriaceae isolates. Indian J Pathol Microbiol. 2014;57:518–9.

    Article  PubMed  Google Scholar 

  24. Kanafani ZA, Dakdouki GK, El-Chammas KI, Eid S, Araj GF, Kanj SS. Bloodstream infections in febrile neutropenic patients at a tertiary care center in Lebanon: a view of the past decade. Int J Infect Dis. 2007;11:450–3.

    Article  PubMed  Google Scholar 

  25. Gonzalez-Barca E, Fernandez-Sevilla A, Carratala J, Salar A, Peris J, Granena A, et al. Prognostic factors influencing mortality in cancer patients with neutropenia and bacteremia. Eur J Clin Microbiol Infect Dis. 1999;18:539–44.

    Article  PubMed  CAS  Google Scholar 

  26. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60.

    Article  PubMed  Google Scholar 

  27. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589–96.

    Article  PubMed  Google Scholar 

  28. Fletcher M, Hodgkiss H, Zhang S, Browning R, Hadden C, Hoffman T, et al. Prompt administration of antibiotics is associated with improved outcomes in febrile neutropenia in children with cancer. Pediatr Blood Cancer. 2013;60:1299–306.

    Article  PubMed  CAS  Google Scholar 

  29. Zhai W, Zhang X, Wei J, Deng Q, Dong X, Zhang X, et al. A prospective observational study of antibiotic therapy in febrile neutropenia patients with hematological malignances from multiple centers in Northeast China. Int J Infect Dis. 2015;37:97–103.

    Article  PubMed  CAS  Google Scholar 

  30. Caselli D, Cesaro S, Ziino O, Zanazzo G, Manicone R, Livadiotti S, et al. Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation. Haematologica. 2010;95:1612–5.

    Article  PubMed  PubMed Central  CAS  Google 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.

    Article  PubMed  Google Scholar 

  32. Du B, Long Y, Liu H, Chen D, Liu D, Xu Y, et al. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome. Intensive Care Med. 2002;28:1718–23.

    Article  PubMed  Google 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 

  34. Kara O, Zarakolu P, Ascioglu S, Etgul S, Uz B, Buyukasik Y, et al. Epidemiology and emerging resistance in bacterial bloodstream infections in patients with hematologic malignancies. Infect Dis (Lond). 2015;47:686–93.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

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.

Funding

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.

Author information

Author notes

  1. Yishu Tang and Qian Cheng contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China

    Yishu Tang, Qian Cheng, Jing Liu, Tianyi Zhou, Huiqi Zeng & Xin Li

  2. Department of Medicine, Yale New Haven Hospital, New Haven, CT, USA

    Qing Yang

  3. Department of Clinical Laboratory, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China

    Di Zhang, Li Zhou, QinJin Wang & Huan Wei

  4. Department of Clinical Laboratory, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China

    Wei Cao

  5. Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Qingxia Liu

Authors
  1. Yishu Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qian Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qing Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Di Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qingxia Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tianyi Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Huiqi Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Li Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. QinJin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Huan Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Xin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xin Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest. All authors meet the ICMJE authorship criteria.

Ethical approval

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.

Informed consent

The requirement for informed consent from patients was also waived.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tang, Y., Cheng, Q., Yang, Q. et al. Prognostic factors and scoring model of hematological malignancies patients with bloodstream infections. Infection 46, 513–521 (2018). https://doi.org/10.1007/s15010-018-1151-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1151-3

Keywords

Search

Navigation