Impact of Infection Patterns on the Outcomes of Patients with Hematological Malignancies in Southwest China: A 10-Year Retrospective Case-Control Study

作者全名："Yang, Yali; Li, Junjie; Huang, Shifeng; Li, Junnan; Yang, Shuangshuang"

作者地址："[Yang, Yali; Huang, Shifeng; Yang, Shuangshuang] Chongqing Med Univ, Affiliated Hosp 1, Dept Lab Med, Chongqing, Peoples R China; [Li, Junjie] Chongqing Med Univ, Dept Lab Med, Key Lab Lab Med Diagnost, Minist Educ, Chongqing, Peoples R China; [Li, Junnan] Chongqing Med Univ, Affiliated Hosp 1, Dept Hematol, Chongqing, Peoples R China; [Yang, Shuangshuang] Chongqing Med Univ, Affiliated Hosp 1, Dept Lab Med, 1 Youyi Rd, Chongqing 400016, Peoples R China"

通信作者："Yang, SS (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Lab Med, 1 Youyi Rd, Chongqing 400016, Peoples R China."

来源：INFECTION AND DRUG RESISTANCE

ESI学科分类：IMMUNOLOGY

WOS号：WOS:001009964100001

JCR分区：Q2

影响因子：2.9

年份：2023

卷号：16

期号：　

开始页：3659

结束页：3669

文献类型：Article

关键词：early survival; hematological malignancies; in-hospital mortality; microbial co-infection; septic shock; determinants

摘要："Background: This study aimed to assess the effect of infection patterns on the outcomes of patients with hematological malignancies (HM) and to identify the determinants of in-hospital mortality.Methods: A case-control study was retrospectively conducted in a tertiary teaching hospital in Chongqing, Southwest China from 2011 to 2020. Clinical characteristics, microbial findings, and outcomes of HM patients with infections were retrieved from the hospital information system. Chi-square or Fisher's exact test was adopted to test the significance of mortality rate. Kaplan-Meier survival analysis and Log rank test were applied to evaluate and compare the 30-day survival rates of those groups. Binary logistic regression, Cox proportional hazards regression, and receiver operating characteristic curves were used to investigate the determinants of in-hospital mortality.Results: Of 1,570 enrolled participants, 43.63% suffered from acute myeloid leukemia, 69.62% received chemotherapy, and 25.73% had hematopoietic stem cell transplantation (HSCT). Microbial infection was documented in 83.38% of participants. Co-infection and septic shock were reported in 32.87% and 5.67% of participants, respectively. Patients with septic shock suffered a significantly lower 30-day survival rate, while those with distinct types of pathogens or co-infections had a comparable 30-day survival rate. The all-cause in-hospital mortality was 7.01% and higher mortality rate was observed in patients with allo-HSCT (7.20%), co-infection (9.88%), and septic shock (33.71%). Cox proportional hazards regression illustrated that elderly age, septic shock, and elevated procalcitonin (PCT) were independent predictors of in-hospital mortality. A PCT cut-off value of 0.24 ng/mL predicted in-hospital mortality with a sensitivity of 77.45% and a specificity of 59.80% (95% CI = 0.684-0.779, P<0.0001).Conclusion: Distinct infectious patterns of HM inpatients were previously unreported in Southwest China. It was the severity of infection, not co-infection, source of infection, or type of causative pathogen that positively related to poor outcome. PCT guided early recognition and treatment of septic shock were advocated."

基金机构："National Natural Science Foundation of China [82002255]; Natural Science Foundation of Chongqing, China [cstc2021jcyj-msxmX0217]; Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) [2022QNXM002]; CQMU Program for Youth Innovation in Future Medicine [W0104]"

基金资助正文："This work is sponsored by National Natural Science Foundation of China (82002255) , Natural Science Foundation of Chongqing, China (cstc2021jcyj-msxmX0217) , Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau, 2022QNXM002) and CQMU Program for Youth Innovation in Future Medicine (W0104) ."