A Scoring System for Predicting the Prognosis of Late-Onset Severe Pneumonia after Allogeneic Hematopoietic Stem Cell Transplantation.

Abstract

Late-onset severe pneumonia (LOSP) is defined as severe pneumonia developing during the late phase of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Because of the high mortality in patients with LOSP, it is important to identify prognostic factors. In this study, we aimed to develop a risk score system with broad applicability that can help predict the risk of LOSP-associated mortality. We retrospectively analyzed 100 patients with LOSP after allo-HSCT between June 2009 and July 2017. The assessment variables included immune, nutritional, and metabolic parameters at the onset of LOSP. Of these 100 patients, 45 (45%) eventually died, and 55 (55%) were positive for organisms, most commonly viruses. In the multivariate analysis, higher monocyte count (≥0.20 × 109/L versus <0.20 × 109/L; P = .001), higher albumin level (≥30.5 g/L versus <30.5 g/L; P = .044), lower lactic dehydrogenase level (<250 U/L versus ≥250 U/L; P = .008) and lower blood urea nitrogen concentration (<7.2 mmol/L versus ≥7.2 mmol/L; P = .026) at the onset of LOSP were significantly associated with better 60-day survival. A risk score system based on the foregoing results showed that the probability of 60-day survival decreased with increasing risk factors, from 96.3% in the low-risk group to 49.1% in the intermediate-risk group and 12.5% in the high-risk group. Our results indicate that this scoring system using 4 variables can stratify patients with different probabilities of survival after LOSP, which suggests that patients' immune, nutritional, and metabolic status are crucial factors in determining outcome.

• Authors: Le-Qing Cao, Jing-Rui Zhou, Xiao-Hui Zhang, Lan-Ping Xu, Yu Wang, Yu-Hong Chen, Huan Chen, Yao Chen, Wei Han, Chen-Hua Yan, Yuan-Yuan Zhang, Feng-Rong Wang, Jun Kong, Zhi-Dong Wang, Yi-Fei Cheng, Jing-Zhi Wang, Xiao-Dong Mo, Ting-Ting Han, Xiao-Su Zhao, Ying-Jun Chang, Kai-Yan Liu, Xiao-Jun Huang, Yu-Qian Sun
• Journal: Transplantation and cellular therapy (Transplant Cell Ther) Vol. 27 Issue 10 Pg. 870.e1-870.e7 (10 2021) ISSN: 2666-6367 [Electronic] United States
• PMID: 34229053 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Topics

• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Pneumonia (diagnosis)
• Prognosis
• Retrospective Studies
• Transplantation, Homologous