Risk Prediction and Prognosis of Invasive Fungal Disease in Hematological Malignancies Patients Complicated with Bloodstream Infections
Risk Prediction and Prognosis of Invasive Fungal Disease in Hematological Malignancies Patients Complicated with Bloodstream Infections
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血液系统恶性肿瘤并发血流感染患者侵袭性真菌病的风险预测和预后
DOI：
10.2147/cmar.s238166
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发表时间：
2020-03
影响因子：
3.3
通讯作者：
Li Xin
中科院分区：
文献类型：
--
作者：
Xiao Han;Tang Yishu;Cheng Qian;Liu Jing;Li Xin
目的：在血液恶性肿瘤（HM）患者中，血液感染（BSI）和侵袭性真菌病（IFD）仍然是导致相当高死亡率和发病率的重要并发症。目前，IFD的发病率和HM合并BSI患者的抗真菌治疗策略尚不清楚。患者和方法：回顾性分析3家医院1374例确诊BSI的HM患者的患者特征、感染相关变量和治疗相关特征，探讨IFD的流行病学、危险因素和预后。结果：HM合并BSI患者确诊和疑似IFD的发病率为11.2%，病死率为40.5%。现有的IFD风险评分在区分这些受益于抗真菌预防的患者方面不够准确。多因素logistic回归发现，年龄介于45岁之间、深度中性粒细胞减少症、低蛋白血症和血管加压药物的使用是与BSI患者IFD发病率相关的独立变量。在确诊和疑似IFD患者中，年龄bbbb45岁，Pitt菌血症评分bbbb3，使用血管加压剂，凝血异常，发热后72小时内开始抗真菌治疗是独立的预后因素。具有IFD高危因素的患者，如果在发热后72小时内开始抗真菌治疗，死亡率明显低于未开始抗真菌治疗的患者。结论：HM合并BSI患者IFD的发病率和死亡率明显增高。早期抗真菌治疗可改善BSI合并IFD危险因素的HM患者的预后。
Purpose: In patients with hematologic malignancies (HM), bloodstream infections (BSI) and invasive fungal disease (IFD) remain important complications causing considerable mortality and morbidity. At present, the morbidity of IFD and the strategies to initiate antifungal treatment in HM patients with BSI remain unclear. Patients and Methods: Patient characteristics, infection-related variables, and therapy-related features of 1374 HM patients with proven BSI from three hospitals were reviewed to investigate the epidemiology, risk factors and prognosis of IFD. Results: The morbidity of proven and probable IFD in HM patients with BSI was 11.2%, and the mortality of those patients was 40.5%. Existing IFD risk scores were not accurate enough in distinguishing these patients benefiting from antifungal prophylaxis. Multivariate logistic regression identified age >45 years, profound neutropenia, hypoproteinemia, and use of vasopressors as independent variables associated with IFD morbidity in HM patients with BSI. In patients with proven and probable IFD patients, age >45 years, Pitt bacteremia score >3, use of vasopressors, abnormal blood coagulation, and initiation of antifungal therapy within 72 hrs after the onset of fever were independent prognostic factors. The mortality was significantly reduced in patients with high-risk factors of IFD if they initiate antifungal treatment within 72 hrs after the onset of fever compared to the patients not. Conclusion: The morbidity and mortality of IFD increase significantly in HM patients with BSI. Early antifungal therapy may improve prognosis in HM patients with BSI complicated with IFD risk factors.
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影响因子：
1.4
作者：
Hirozumi Sano;R. Kobayashi;D. Suzuki;K. Kishimoto;K. Yasuda;K. Kobayashi
通讯作者：
Hirozumi Sano;R. Kobayashi;D. Suzuki;K. Kishimoto;K. Yasuda;K. Kobayashi
影响因子：
5.5
作者：
Criscuolo, Marianna;Marchesi, Francesco;Russo, D.
通讯作者：
Russo, D.
DOI：
10.1111/j.1469-0691.2012.03906.x
发表时间：
2013-01
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Kim SH;Yoon YK;Kim MJ;Sohn JW
通讯作者：
Sohn JW
DOI：
10.1186/cc10574
发表时间：
2011
期刊：
Critical care (London, England)
影响因子：
--
作者：
Muskett H;Shahin J;Eyres G;Harvey S;Rowan K;Harrison D
通讯作者：
Harrison D
DOI：
10.6004/jnccn.2008.0013
发表时间：
2012
期刊：
Journal of the National Comprehensive Cancer Network : JNCCN
影响因子：
--
作者：
L. Baden;W. Bensinger;M. Angarone;C. Casper;E. Dubberke;A. Freifeld;R. Garzon;J. Greene;J. Greer;J. Ito;J. Karp;D. Kaul;E. King;Emily R. Mackler;K. Marr;J. Montoya;Ashley Morris-Engemann;P. Pappas;K. Rolston;B. Segal;S. Seo;S. Swaminathan;M. Naganuma;Dorothy Shead
通讯作者：
L. Baden;W. Bensinger;M. Angarone;C. Casper;E. Dubberke;A. Freifeld;R. Garzon;J. Greene;J. Greer;J. Ito;J. Karp;D. Kaul;E. King;Emily R. Mackler;K. Marr;J. Montoya;Ashley Morris-Engemann;P. Pappas;K. Rolston;B. Segal;S. Seo;S. Swaminathan;M. Naganuma;Dorothy Shead