Infection and Drug Resistance (Jan 2023)

A Visualized Mortality Prediction Score Model in Hematological Malignancies Patients with Carbapenem-Resistant Organisms Bloodstream Infection

  • Qian C,
  • Wu Q,
  • Ruan Z,
  • Liu F,
  • Li W,
  • Shi W,
  • Ma L,
  • Peng D,
  • Yin H,
  • Yao L,
  • Li Z,
  • Hong M,
  • Xia L

Journal volume & issue
Vol. Volume 16
pp. 201 – 215

Abstract

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Chenjing Qian,1,* Qiuling Wu,1,* Zhixuan Ruan,2 Fang Liu,1 Weiming Li,1 Wei Shi,1 Ling Ma,3 Danyue Peng,1 Hua Yin,1 Lan Yao,1 Zixuan Li,1 Mei Hong,1,4 Linghui Xia1 1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People’s Republic of China; 2Faculty of Natural, Mathematical and Engineering Sciences, King’s College, London, UK; 3Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 4Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mei Hong; Linghui Xia, Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei Province, People’s Republic of China, Tel +8613037137937 ; +8618627733999, Email [email protected]; [email protected]: Bloodstream infection (BSI) due to carbapenem-resistant organisms (CROs) has emerged as a worldwide problem associated with high mortality. This study aimed to evaluate the risk factors associated with mortality in HM patients with CROs BSI and to establish a scoring model for early mortality prediction.Methods: We conducted a retrospective cohort study at our hematological department from January 2018 to December 2021, including all HM patients with CROs BSI. The outcome measured was death within 30-day of BSI onset. Survivor and non-survivor subgroups were compared to identify predictors of mortality. Univariate and multivariate Cox regression analyses were used to identify prognostic risk factors and develop a nomogram.Results: In total, 150 HM patients were included in the study showing an overall 30-day mortality rate of 56%. Klebsiella pneumonia was the dominant episode. Cox regression analysis showed that pre-infection length of stay was > 14 days (score 41), Pitt score > 4 (score 100), mucositis (score 41), CAR (The ratio of C-reactive protein to albumin) > 8.8 (score 57), early definitive therapy (score 44), and long-duration (score 78) were positive independent risk predictors associated with 30-day mortality, all of which were selected into the nomogram. Furthermore, all patients were divided into the high-risk group (≥ 160 points) or the low-risk group based on the prediction score model. The mortality of the high-risk group was 8 times more than the low-risk group. Kaplan-Meier analysis showed that empirical polymyxin B therapy was associated with a lower 30-day mortality rate, which was identified as a good prognostic factor in the high-risk group. In comparison, empirical carbapenems and tigecycline were poor prognostic factors in a low-risk group.Conclusion: Our score model can accurately predict 30-day mortality in HM patients with CROs BSI. Early administration of CROs-targeted therapy in the high-risk group is strongly recommended to decrease mortality.Keywords: carbapenem-resistant organisms, predictive model, nomogram, hematological malignancies, bloodstream infection

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