A risk prediction score for invasive mold disease in patients with hematological malignancies.
A risk prediction score for invasive mold disease in patients with hematological malignancies.
复制标题
血液恶性肿瘤患者的侵入性霉菌疾病的风险预测评分。
DOI：
10.1371/journal.pone.0075531
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Vianelli N
中科院分区：
文献类型：
--
作者：
Stanzani M;Lewis RE;Fiacchini M;Ricci P;Tumietto F;Viale P;Ambretti S;Baccarani M;Cavo M;Vianelli N
恶性血液病患者侵袭性霉菌病（IMD）的风险评分有助于患者筛查，并提高抗真菌预防的靶向使用。我们回顾性分析了2005-2008年840例血液系统恶性肿瘤患者的1,709例住院病例，以收集IMD的17个流行病学和治疗相关危险因素的数据。基于与已证实或可能的IMD相关的独立风险因素，使用多变量回归来开发加权风险评分，该评分在2009-2012年855例患者的1，746例住院期间进行了前瞻性验证。在分析的17个候选变量中，通过单变量分析，11个与IMD相关，但只有4个风险因素（异基因造血干细胞移植受者中的中性粒细胞减少症、淋巴细胞减少症或淋巴细胞功能障碍、恶性肿瘤状态和既往IMD）保留在最终的多变量模型中，导致加权风险评分为0-13。风险评分< 6区分IMD发生率低（< 1%）与较高（> 5%）的患者，阴性预测值（NPV）为0.99（95%CI 0.98-0.99）。在2009-2012年期间，入院时计算的风险评分为6的患者< 6 had significantly lower 90-day incidence rates of IMD compared to patients with scores >（0.9% vs. 10.6%，P <0.001）。IMD的客观加权风险评分可以准确区分患有血液恶性肿瘤的患者，这些患者患霉菌疾病的风险较低，并且可能有助于“筛查”不太可能从强化诊断监测或针对霉菌的抗真菌预防中受益的低风险患者。
A risk score for invasive mold disease (IMD) in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis. We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies (2005-2008) to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012. Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors (neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD) were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of < 6 discriminated patients with low (< 1%) versus higher incidence rates (> 5%) of IMD, with a negative predictive value (NPV) of 0.99, (95% CI 0.98-0.99). During 2009-2012, patients with a calculated risk score at admission of < 6 had significantly lower 90-day incidence rates of IMD compared to patients with scores > 6 (0.9% vs. 10.6%, P <0.001). An objective, weighted risk score for IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate “screening-out” of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.
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影响因子：
14.2
作者：
Berthelot, P.;Loulergue, P.;Guyotat, D.
通讯作者：
Guyotat, D.
影响因子：
4.3
作者：
labbe, Annie-Claude;Su, Shi Hann;Roy, Jean
通讯作者：
Roy, Jean
影响因子：
4.9
作者：
Ostrosky-Zeichner, Luis;Pappas, Peter G.;Sobel, Jack D.
通讯作者：
Sobel, Jack D.
DOI：
10.1086/591969
发表时间：
2008-10-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Garcia-Vidal C;Upton A;Kirby KA;Marr KA
通讯作者：
Marr KA
影响因子：
11.8
作者：
Gavalda, J;Len, O;Pahissa, A
通讯作者：
Pahissa, A