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摘要
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. %26lt;br%26gt;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. %26lt;br%26gt;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 %26lt; 6 discriminated patients with low (%26lt; 1%) versus higher incidence rates (%26gt; 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 %26lt; 6 had significantly lower 90-day incidence rates of IMD compared to patients with scores %26gt; 6 (0.9% vs. 10.6%, P %26lt; 0.001). %26lt;br%26gt;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 %26quot;screening-out%26quot; of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.
- 出版日期2013-9-26
