C-reactive protein and the MASCC risk index identify high-risk patients with febrile neutropenia and hematologic neoplasms
C-reactive protein and the MASCC risk index identify high-risk patients with febrile neutropenia and hematologic neoplasms
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DOI：
10.1007/s00520-014-2454-2
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发表时间：
2015-04-01
影响因子：
3.1
通讯作者：
Arango, Marcos
中科院分区：
文献类型：
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作者：
Combariza, Juan F.;Lombana, Milton;Arango, Marcos
本研究的目的是评估多国癌症支持护理协会(MASCC)风险评分与C反应蛋白(CRP)值之间的相关性，以判断高危中性粒细胞减少症和血液肿瘤患者的预后。本研究进行了一项回顾性队列研究，其中MASCC评分和CRP值用于评估中性粒细胞减少症和恶性血液病患者30天内的死亡风险。根据MASCC评分的高危患者明显更有可能经历不良后果，如被转移到重症监护病房(RR3.55；CI 95%2.73-6.62p<；0.001)和死亡(RR2.21CI95%1.742.79，p<；0.001)。多因素分析显示MASCC评分(HR3.0；CI 95%1.12-13.54，p=0.032)和C反应蛋白平均水平(HR 17；CI 95%2.21-136.48，p=0.007)与生存率密切相关。MASCC评分低、C反应蛋白平均<15 mg/dL的患者30天内存活率为100%。对于平均C反应蛋白>15 mg/dL的高危患者，这一比率仅为%。MASCC风险评分结合平均C反应蛋白值，成功地识别出高热中性粒细胞减少症、血液系统恶性肿瘤和高死亡风险的患者。
The objective of this study is to assess the prognostic usefulness of the Multinational Association of Supportive Care in Cancer (MASCC) risk score in association with the value of C-reactive protein (CRP) to identify high-risk patients with febrile neutropenia and hematologic neoplasms.A retrospective cohort study in which the MASCC score and the CRP values were used to assess the mortality risk at 30 days among patients with febrile neutropenia and hematologic malignancies was performed.Two hundred thiry-seven patients with febrile neutropenia were analyzed; the mortality rate within 30 days was 9 %. High-risk patients according to the MASCC score were significantly more likely to experience adverse outcomes, such as being transferred to the intensive care unit (RR 3.55; CI 95 % 2.73-6.62, p < 0.001) and death (RR 2.21; CI 95 % 1.74-2.79, p < 0.001). Multivariate analysis showed a strong association between the high-risk group identified by the MASCC score (HR 3.0; CI 95 % 1.12-13.54, p = 0.032) and the mean levels of CRP (HR 17; CI 95 % 2.21-136.48, p = 0.007) and survival. The survival rate within 30 days was 100 % for the patients with a low-risk MASCC score and a mean CRP less than 15 mg/dL. This rate was only 64 % for high-risk patients with a mean CRP greater than 15 mg/dL.The MASCC risk score combined with the mean CRP value successfully identifies patients with febrile neutropenia and hematological malignancies and a high risk of death.