Analysis of risk factors related to the prognosis in patients with late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation
10.3760/cma.j.issn.0578-1426.2017.11.006
- VernacularTitle:异基因造血干细胞移植后晚发重症肺炎患者预后危险因素分析
- Author:
Yao CHEN
1
;
Yu WANG
;
Zhihong JIANG
;
Lanping XU
;
Xiaohui ZHANG
;
Huan CHEN
;
Yuhong CHEN
;
Fengrong WANG
;
Jingzhi WANG
Author Information
1. 100044,北京大学人民医院血液病研究所 造血干细胞移植治疗血液病北京市重点实验室
- Keywords:
Hematopoietic stem cell transplantation;
Severe pneumonia;
Risk factors
- From:
Chinese Journal of Internal Medicine
2017;56(11):804-809
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the prognostic factors of late-onset severe pneumonia ( LOSP) in patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods From January 2009 to December 2015, 68 patients with LOSP after allo-HSCT at Peking University Institute of Hematology were enrolled.In this retrospective study , univariate and multivariate analysis were used to evaluate the prognostic factors for LOSP after allo-HSCT.Results The median time from allo-HSCT to the development of LOSP was 213 ( 90-2330 ) days.The overall survival rate was 42.6% ( 29/68 ) .The median survival time from LOSP to death was 21 days.Early mortality was defined as death within 21 days after LOSP, as late death more than or equal to 21 days.The median oxygenation index was 199.15 (92.21-290.48) mmHg.LOSPs in thirty-two patients (36.8%) were caused by virus, bacteria, fungi or mixed pathogens.The median C-reactive protein (CRP) was 75.65 (0.94-451.00) mg/L.The median procalcitonin ( PCT) was 0.66 ( 0.00 -249.00 ) μg/L.The higher PCT value indicated an early higher mortality rate by the ROC curve (PCT:cut-off≥0.94μg/L).Furthermore, multivariate analysis suggested that PCT more than or equal to 0.94 μg/L was a risk factor for early death of LOSP ( OR=5.77, 95%CI 1.66-20.11, P=0.006).LOSP occurred later or equal to 213 days after allo-HSCT was also a risk factor of early death in LOSP ( OR=4.74, 95%CI 1.33 -16.89, P=0.017 ) .No previous history of chronic graft versus host disease (GVHD) (OR=4.50, 95%CI 1.58 -12.83, P=0.005) and LOSP later or equal to 213 days ( OR=4.40, 95%CI 1.61 -11.99,P=0.004) were the risk factors of late death in LOSP.Conclusions PCT more than or equal to 0.94 μg/L and LOSP later or equal to 213 days are the risk factors of early death in LOSP .No previous chronic GVHD and LOSP later or equal to 213 days are the risk factors of late death in LOSP .
