Factors affecting thrombohemorrhagic early death in patients with acute promyelocytic leukemia treated with arsenic trioxide alone
Factors affecting thrombohemorrhagic early death in patients with acute promyelocytic leukemia treated with arsenic trioxide alone
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DOI：
10.1016/j.bcmd.2019.102351
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发表时间：
2019-11-01
影响因子：
2.3
通讯作者：
Zhou, Jin
中科院分区：
文献类型：
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作者：
Hou, Wenyi;Zhang, Yingmei;Zhou, Jin
急性早幼粒细胞白血病 (APL) 通常伴有潜在的破坏性凝血病。血栓出血性早期死亡 (TH-ED)/早期出血性死亡的预测因素尚不明确。在这项回顾性研究中，选择了 11 个可以轻松快速评估的基线临床变量，对 364 名 APL 患者进行评估，这些患者仅接受三氧化二砷 (ATO) 作为缓解诱导治疗。 TH-ED定义为入院后30天内因出血或血栓形成死亡。 Cox比例风险回归模型用于单变量和多变量分析。共有53例患者死于严重出血（51例）或血栓（2例），30天时TH-ED的累积发生率为14.6%。确定了 TH-ED 的 6 个独立危险因素，包括复发、男性、白细胞 (WBC) 计数高于 10 x 10(9)/L、纤维蛋白原水平低于 1 g/L、D-二聚体水平高于 4 mg/L 和肌酐水平升高。肌酐水平升高是最重要的危险因素，其次是白细胞计数 > 10 x 10(9)/L。这项研究在一大群 APL 患者中确定了 TH-ED 的危险因素，丰富了识别 TH-ED 高风险患者的临床信息。
Acute promyelocytic leukemia (APL) is often accompanied by a potentially devastating coagulopathy. Predictors of thrombohemorrhagic early death (TH-ED)/early bleeding death are not well characterized. In this retrospective study, eleven baseline clinical variables that can be assessed easily and promptly were chosen for evaluation in a cohort of 364 patients with APL who were administered arsenic trioxide (ATO) alone as remission induction therapy. TH-ED was defined as death from bleeding or thrombosis within 30 days after hospital admission. Cox proportional hazards regression model was used for both the univariate and multivariate analyses. Totally, 53 patients died from severe bleeding (51 cases) or thrombosis (2 cases), and at 30 days the cumulative incidences of TH-ED were 14.6%. Six independent risk factors for TH-ED were identified, including relapse, male, white blood cell (WBC) count above 10 x 10(9)/L, fibrinogen level below 1 g/L, D-dimer level above 4 mg/L and increased creatinine level. Increased creatinine level was the most powerful risk factor, followed by WBC count > 10 x 10(9)/L. This study identified risk factors for TH-ED in a large cohort of patients with APL, which enriched clinical information on identifying patients at high risk of TH-ED.