Antifungal Strategy in Patients with Invasive Fungal Disease Associated with Hematological Malignancies Based on Risk Stratification.
Antifungal Strategy in Patients with Invasive Fungal Disease Associated with Hematological Malignancies Based on Risk Stratification.
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基于风险分层的血液系统恶性肿瘤相关侵袭性真菌病患者的抗真菌策略
DOI：
10.1155/2022/1743596
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发表时间：
2022
影响因子：
2.8
通讯作者：
Hu, Jianda
中科院分区：
文献类型：
--
作者：
Chen, Lijin;Luo, Luting;Chen, Yanxin;Wang, Yinzhou;Li, Jing;Zheng, Xiaoyun;Yang, Ting;Hu, Jianda
血液系统恶性肿瘤（HM）患者常发生侵袭性真菌病（IFD），导致较高的发病率和死亡率。虽然有治疗指南，但用于优化抗真菌治疗策略的风险分层模型却很少。对458例患有IFD的HM患者的临床记录进行了回顾性分析。按照中国的治疗指南，患者接受了经验性治疗（n = 239）或诊断驱动治疗（n = 219）。经验性治疗组的有效率为87.9%，诊断驱动治疗组为81.7%（P≥0.05）。不良反应发生率分别为18.4%和16.9%（P≥0.05）。通过卡方检验和逻辑回归模型在单因素分析和多因素分析中对HM患者中IFD的所有风险因素进行了评估。在多因素分析中，持续时间≥14天（OR = 18.340，P = 0.011）、复发/难治性疾病（OR = 11.670，P = 0.005）、IFD病史（OR = 5.270，P = 0.021）以及糖尿病（OR = 3.120，P = 0.035）与IFD显著相关。具有3个以上这些因素的患者在经验性治疗（85.7%）和诊断驱动治疗（41.6%）的有效率方面存在显著差异（P = 0.008）。在具有两个风险因素的患者中，经验性治疗和诊断驱动治疗的有效率分别为80.6%和70.9%（P＞0.05），在具有一个风险因素的患者中分别为85.1%和85.4%（P＞0.05）。因此，具有一个或两个风险因素的患者在有效性方面没有显著差异。上述风险分层可指导临床抗真菌治疗。具有3个或更多风险因素的患者从经验性治疗中获益。
Patients with hematological malignancies (HM) often develop the invasive fungal disease (IFD), causing important morbidity/mortality. While treatment guidelines are available, risk stratification models for optimizing antifungal therapy strategies are few. Clinical records from 458 HM patients with IFD were retrospectively analyzed. Following Chinese treatment guidelines, patients received empirical (n = 239) or diagnostic-driven therapy (n = 219). The effectiveness rate was 87.9% for the empirical and 81.7% for the diagnostic-driven therapy groups (P ≥ 0.05). The incidence of adverse reactions was 18.4% and 16.9%, respectively (P ≥ 0.05). All risk factors of IFD in HM patients were estimated in the univariate analyses and multivariate analyses by the chi-square test and logistic regression model. Duration ≥14 days (OR = 18.340, P=0.011), relapsed/refractory disease (OR = 11.670, P=0.005), IFD history (OR = 5.270, P=0.021), and diabetes (OR = 3.120, P=0.035) were significantly associated with IFD in the multivariate analysis. Patients with more than 3 of these factors have a significant difference in effective rates between the empirical (85.7%) and diagnostic-driven (41.6%) therapy (P=0.008). Empirical and diagnostic-driven therapy effective rates were 80.6% and 70.9% in the patients with two risk factors (P > 0.05) and 85.1% and 85.4% in the patients with one risk factor (P > 0.05). Thus, there was no significant difference in effectiveness in patients with one or two risk factors. The abovementioned risk stratification can guide clinical antifungal therapy. The patients with 3 or more risk factors benefit from empirical therapy.
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影响因子：
5.7
作者：
Murphy SE;Bicanic T
通讯作者：
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影响因子：
3.2
作者：
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DOI：
10.4084/mjhid.2017.012
发表时间：
2017
影响因子：
3.2
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影响因子：
3.7
作者：
Stanzani M;Lewis RE;Fiacchini M;Ricci P;Tumietto F;Viale P;Ambretti S;Baccarani M;Cavo M;Vianelli N
通讯作者：
Vianelli N