title: Retrospective evaluation of the area over the neutrophil curve index to predict early infection in hematopoietic stem cell transplantation recipients.
abstract: 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.
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitana, Japan.
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Kimura
authors.forename: Kumi
authors.initials: K
authors.lastname: Oshima
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Miki
authors.initials: M
authors.lastname: Sato
authors.forename: Kiriko
authors.initials: K
authors.lastname: Terasako
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.forename: Misato
authors.initials: M
authors.lastname: Kikuchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Okuda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.forename: Rie
authors.initials: R
authors.lastname: Yamazaki
authors.forename: Yukie
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Aki
authors.initials: A
authors.lastname: Tanihara
authors.forename: Junji
authors.initials: J
authors.lastname: Nishida
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents