Early Diagnosis of Neutropenic Enterocolitis by Bedside Ultrasound in Hematological Malignancies: A Prospective Study.
Early Diagnosis of Neutropenic Enterocolitis by Bedside Ultrasound in Hematological Malignancies: A Prospective Study.
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DOI：
10.3390/jcm10184277
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发表时间：
2021-09-21
影响因子：
3.9
通讯作者：
Petrini M
中科院分区：
文献类型：
--
作者：
Benedetti E;Bruno B;Martini F;Morganti R;Bramanti E;Caracciolo F;Galimberti S;Lippolis P;Neri E;Arena C;Cerri F;Ricchiuto V;Pelosini M;Orciuolo E;Petrini M
(1)背景：中性粒细胞减少性小肠结肠炎（NEC）是化疗后的一种危及生命的并发症，死亡率高。早期诊断对改善预后至关重要。我们设计了一项大型前瞻性研究，采用床旁超声检查（US）作为一种新的方法，使早期诊断和及时治疗，以降低死亡率。(2)研究方法：NEC定义为US或计算机断层扫描（CT）证实的肠壁厚度≥ 4 mm，出现以下至少一种症状：发热和/或腹痛和/或中性粒细胞减少症期间腹泻。从2007年至2018年，1754例连续患者接受了基线床旁超声检查，这些检查在提示NEC的症状发作后12小时内重复进行。(3)结果：总的来说，观察到117例NEC，总死亡率为9.4%。阴性对照组中始终不存在肠壁增厚。腹痛伴一种或多种症状与诊断的相对危险度（17.33）、敏感性（89.7%）、特异性（100%）和准确性（96.2%）最高。发作时腹痛和发热的组合与较差的生存率显著相关（p < 0.0001，OR 13.85）。BWT（p = 0.046）、治疗类型（p = 0.049）和血培养阳性（p = 0.003）与生存率较差相关。(4)结论：床旁超声是一种无创、无辐射的影像学技术，可早期诊断NEC，及时治疗可显著降低死亡率。
(1) Background: Neutropenic enterocolitis (NEC) is a life-threatening complication following chemotherapy with high mortality rates. Early diagnosis is crucial to improve outcomes. We designed a large prospective study employing bedside ultrasonography (US) as a novel approach to allow early diagnosis and prompt treatment to reduce mortality. (2) Methods: NEC was defined as US or computed tomography (CT)-proven bowel wall thickness ≥ 4 mm at the onset of at least one of the following symptoms: fever and/or abdominal pain and/or diarrhea during neutropenia. From 2007 to 2018, 1754 consecutive patients underwent baseline bedside US that was invariably repeated within 12 h from the onset of symptom(s) suggestive of NEC. (3) Results: Overall, 117 episodes of NEC were observed, and overall mortality was 9.4%. Bowel wall thickening was invariably absent in the negative control group. Abdominal pain associated with one or more symptoms correlated with the highest relative risk (17.33), sensitivity (89.7%), specificity (100%), and accuracy (96.2%) for diagnosis. The combination of abdominal pain and fever at onset significantly correlated with worse survival (p < 0.0001, OR 13.85). BWT (p = 0.046), type of therapy (p = 0.049) and blood culture positivity (p = 0.003) correlated with worse survival. (4) Conclusions: Bedside ultrasound is a non-invasive and radiation free imaging technique for early diagnosis of NEC and its prompt treatment significantly reduced mortality.
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影响因子：
2.9
作者：
BOLONDI, L;CASANOVA, P;LABO, G
通讯作者：
LABO, G
影响因子：
3.7
作者：
Gorschluter, M;Mey, U;Glasmacher, A
通讯作者：
Glasmacher, A
影响因子：
3.3
作者：
Hollerweger, Alois
通讯作者：
Hollerweger, Alois
影响因子：
2
作者：
Benedetti, E;Lippolis, P V;Petrini, M
通讯作者：
Petrini, M
影响因子：
4.3
作者：
Dietrich, Christoph F.;Hermann, Stella;Braden, Barbara
通讯作者：
Braden, Barbara