A Risk Prediction Score for Invasive Mold Disease in Patients with Hematological MalignanciesReportar como inadecuado




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Background

A risk score for invasive mold disease IMD in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis.

Methods

We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies 2005-2008 to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012.

Results

Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of < 6 discriminated patients with low < 1% versus higher incidence rates > 5% of IMD, with a negative predictive value NPV of 0.99, 95% CI 0.98-0.99. During 2009-2012, patients with a calculated risk score at admission of < 6 had significantly lower 90-day incidence rates of IMD compared to patients with scores > 6 0.9% vs. 10.6%, P <0.001.

Conclusion

An objective, weighted risk score for IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate -screening-out- of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.



Autor: Marta Stanzani , Russell E. Lewis, Mauro Fiacchini, Paolo Ricci, Fabio Tumietto, Pierluigi Viale, Simone Ambretti, Michele Baccar

Fuente: http://plos.srce.hr/



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