title: Index to predict invasive mold infection in high-risk neutropenic patients based on the area over the neutrophil curve.
abstract: OBJECTIVE
  Patients with prolonged and profound neutropenia are at high risk to develop invasive mold infections (IMIs). We developed an index (D-index) that combines duration and severity of neutropenia. The aim of this study was to test the D-index as a predictor of IMI.
  
  
  METHODS
  The D-index was based on a graph plotting the absolute neutrophil counts during neutropenia and was the area over the neutrophil curve. We tested the D-index in 11 patients with acute myeloid leukemia (AML) who developed IMI during neutropenia and 33 AML patients without IMI (controls). We also calculated a cumulative D-index (c-D-index), defined as the cumulative D-index from the start of neutropenia until the date of the first clinical manifestation of IMI in patient cases. We compared the D-index and c-D-index with duration of neutropenia and defined a cutoff for IMI using the receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  The median duration of neutropenia and profound neutropenia of patient cases were significantly higher compared with controls (P = .002 and P = .001, respectively), as were the D-index (P < .001) and c-D-index (P = .02). The D-index and c-D-index performed better than duration of neutropenia in ROC curve analysis. For a cutoff point of 5,800 of the c-D-index, the sensitivity and specificity were 91% and 58%, respectively, and for a prevalence of IMI of 5%, 10%, and 15%, the negative predictive values were 99%, 98%, and 97%, respectively.
  
  
  CONCLUSIONS
  The high negative predictive value of the c-D-index may be of help in defining different risks for IMI in febrile neutropenic patients.
authors: University Hospital, Hematology Service, Universidade Federal do Rio de Janeiro, Cidade Universitária, Rio de Janeiro, Brazil.
authors: Rodrigo D
authors: RD
authors: Portugal
authors: Marcia
authors: M
authors: Garnica
authors: Marcio
authors: M
authors: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D019540:Area Under Curve; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D007958:Leukocyte Count; D008297:Male; D008432:Mathematical Computing; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control*; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications* / Q000473:pathology; D009504:Neutrophils; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents