A new prognostic model for chemotherapy-induced febrile neutropenia
A new prognostic model for chemotherapy-induced febrile neutropenia
复制标题
DOI：
10.1007/s10147-015-0853-0
复制
发表时间：
2016-02-01
影响因子：
3.3
通讯作者：
Yoon, Sung-Cheol
中科院分区：
文献类型：
--
作者：
Ahn, Shin;Lee, Yoon-Seon;Yoon, Sung-Cheol
本研究的目的是开发和验证发热性中性粒细胞减少症（FN）的新预后模型。本研究包含1001集FN：衍生集718集，验证集283集。以不良结局为主要终点，菌血症为次要终点，进行多因素logistic回归分析。在衍生集中，不良结局的危险因素包括年龄a千分之一（60岁）（2分），降钙素原a千分之一（0.5 ng/mL）（5分），ECOG表现评分a千分之一（2分），口腔黏膜炎等级a千分之一（3分），收缩压< 90 mmHg（3分），呼吸频率a千分之一（24次呼吸/分钟）（3分）。该模型将患者分为三个严重程度等级，不良事件发生率为I级6.0%（评分为千分之一货币符号2），II级27.3%（评分为3-8），III级67.9%（评分为千分之一日元9）。在I、II和III级患者中，菌血症发生率分别为1.1%、11.5%和29.8%。验证集的结果在每个风险类别中是相似的。当推导集和验证集整合在一起时，根据新预后模型分类的低风险组中有5.9%出现不良结果，而根据跨国癌症支持治疗协会（MASCC）风险指数分类的不良结果为12.2%。有了新的预后模型，我们可以将FN患者分为不良结局和菌血症增加的三类。I类患者可提前出院，II类患者短期观察可安全管理，III类患者需住院。
The objective of this study was to develop and validate a new prognostic model for febrile neutropenia (FN).This study comprised 1001 episodes of FN: 718 for the derivation set and 283 for the validation set. Multivariate logistic regression analysis was performed with unfavorable outcome as the primary endpoint and bacteremia as the secondary endpoint.In the derivation set, risk factors for adverse outcomes comprised age a parts per thousand yen60 years (2 points), procalcitonin a parts per thousand yen0.5 ng/mL (5 points), ECOG performance score a parts per thousand yen2 (2 points), oral mucositis grade a parts per thousand yen3 (3 points), systolic blood pressure < 90 mmHg (3 points), and respiratory rate a parts per thousand yen24 breaths/min (3 points). The model stratified patients into three severity classes, with adverse event rates of 6.0 % in class I (score a parts per thousand currency sign2), 27.3 % in class II (score 3-8), and 67.9 % in class III (score a parts per thousand yen9). Bacteremia was present in 1.1, 11.5, and 29.8 % of patients in class I, II, and III, respectively. The outcomes of the validation set were similar in each risk class. When the derivation and validation sets were integrated, unfavorable outcomes occurred in 5.9 % of the low-risk group classified by the new prognostic model and in 12.2 % classified by the Multinational Association for Supportive Care in Cancer (MASCC) risk index.With the new prognostic model, we can classify patients with FN into three classes of increasing adverse outcomes and bacteremia. Early discharge would be possible for class I patients, short-term observation could safely manage class II patients, and inpatient admission is warranted for class III patients.