Prediction model for mortality after intracranial hemorrhage in patients with leukemia.
Prediction model for mortality after intracranial hemorrhage in patients with leukemia.
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DOI：
10.1002/ajh.22031
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发表时间：
2011-07
影响因子：
12.8
通讯作者：
Garcia-Manero G
中科院分区：
文献类型：
--
作者：
Dayyani F;Mougalian SS;Naqvi K;Shan J;Ravandi F;Cortes J;Weinberg J;Jabbour E;Faderl S;Wierda W;Thomas D;O'Brien S;Pierce S;Kantarjian H;Garcia-Manero G
急性白血病患者颅内出血（ICH）的发病率和死亡率较高。我们从2005-2009年间在我们机构接受治疗的2,421例白血病患者中确定了118例ICH患者，并评估了ICH队列死亡率的预后因素。ICH时的中位年龄为58岁，49%为男性，60%患有急性髓性白血病。慢性粒细胞白血病急变期患者ICH的相对发生率最高（12.1%）。精神状态变化是促使ICH检查的最常见症状。所有患者在ICH发作后的中位生存期为20天。在多变量分析中，四个临床特征被确定为ICH患者死亡率的独立不利因素：白蛋白<3.5 g/dL，乳酸脱氢酶（LDH）>835 U/L，年龄> 60岁，疾病复发状态。根据风险因素的数量，ICH后的死亡率为：25%（0个风险因素），47%（1），78%（2）和>97%（3或4）。总之，发生ICH的白血病患者的预后并不普遍较差，一个简单的评分系统可以为医生和家属提供预后和积极治疗方案的潜在益处的建议。
Intracranial hemorrhage (ICH) is associated with great morbidity and mortality in patients with acute leukemia. We identified 118 patients with ICH from a total of 2,421 patient with leukemia who were treated at our institution between 2005–2009, and assessed the prognostic factors for mortality in the ICH cohort. Median age at time of ICH was 58 years, 49% were male, and 60% had acute myeloid leukemia. The relative incidence of ICH was highest in patients with chronic myeloid leukemia in blast crisis (12.1%). Mental status changes were the most common symptom which prompted work-up for ICH. Median survival for all patients after onset of ICH was 20 days. In multivariate analyses, four clinical characteristics were identified as independent adverse factors for mortality in patients with ICH: albumin <3.5 g/dL, lactate dehydrogenase (LDH) >835 U/L, age > 60 years, and relapsed disease status. Based on the number of risk factors, mortality after ICH was: 25% (0 risk factor), 47% (1), 78% (2), and >97% (3 or 4). In conclusion, patients with leukemia who develop ICH do not have universally poor outcomes, and a simple scoring system could serve to advise physicians and families of the prognosis and the potential benefit of aggressive treatment options.