Retrospective evaluation of the area over the neutrophil curve index to predict early infection in hematopoietic stem cell transplantation recipients.
We investigated the impact of neutropenia on the development of early bloodstream and pulmonary infections in hematopoietic stem cell transplantation (HSCT) recipients, and evaluated the utility of an index (D-index) that reflects both the intensity and duration of neutropenia. Fifty-eight patients (23 autologous, 35 allogeneic HSCT recipients) were enrolled in this retrospective study. The D-index was defined as the area over the neutrophil curve during neutropenia. We also evaluated the utility of the cumulative D-index from the start of neutropenia until the development of infection (c-D-index), which may enable real-time assessment of the risk for infection. The patients showed 12 and 7 episodes of bloodstream and pulmonary infection, respectively. The D-index, days of neutropenia (<500/microL) and days of profound neutropenia (<100/microL) had at least a nearly significant impact on the development of both bloodstream and pulmonary infections. On the other hand, the c-D-index, cumulative days of neutropenia, and cumulative days of profound neutropenia significantly affected pulmonary infection, but not bloodstream infection. The c-D-index had a high negative predictive value of 97.4% for pulmonary infection with a cutoff of 5500, but the area under the receiver operating characteristic curve was similar to that of the cumulative days of neutropenia and profound neutropenia. Our results showed that although the c-D-index may be useful for identifying patients who are at low risk for early pulmonary infection after HSCT, its performance was similar to that of the simple duration of neutropenia.
Kimura
Shun-Ichi
S
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitana, Japan.
Oshima
Kumi
K
Sato
Ken
K
Sato
Miki
M
Terasako
Kiriko
K
Nakasone
Hideki
H
Kikuchi
Misato
M
Okuda
Shinya
S
Kako
Shinichi
S
Yamazaki
Rie
R
Tanaka
Yukie
Y
Tanihara
Aki
A
Nishida
Junji
J
Kanda
Yoshinobu
Y
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use; D019540:Area Under Curve; D016470:Bacteremia / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D016469:Fungemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007958:Leukocyte Count; D008172:Lung Diseases, Fungal / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000601:surgery; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D009504:Neutrophils; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood*; D012189:Retrospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents