A scoring system for predicting the prognosis of late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation.

Cao, Le-Qing; Zhou, Jing-Rui; Zhang, Xiao-Hui; Xu, Lan-Ping; Wang, Yu; Chen, Yu-Hong; Chen, Huan; Chen, Yao; Han, Wei; Yan, Chen-Hua; Zhang, Yuan-Yuan; Wang, Feng-Rong; Kong, Jun; Wang, Zhi-Dong; Cheng, Yi-Fei; Wang, Jing-Zhi; Mo, Xiao-Dong; Han, Ting-Ting; Zhao, Xiao-Su; Chang, Ying-Jun; Liu, Kai-Yan; Huang, Xiao-Jun; Sun, Yu-Qian

BACKGROUND Late-onset severe pneumonia (LOSP) is defined as severe pneumonia developed during the late phase of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Patients with LOSP have high mortality, so it is important to identify prognostic factors. OBJECTIVES In this study, we aimed to develop a risk score system with broad applicability that could help predict the risk of LOSP-associated mortality. STUDY DESIGN We retrospectively analyzed 100 patients with LOSP after allo-HSCT from June 2009 to July 2017. The assessment variables included immune, nutritional and metabolic parameters at the onset of LOSP. RESULTS Of all 100 patients who suffered LOSP after allo-HSCT, 45 (45%) patients eventually died, and 55 (55%) patients were positive for organisms, with the most common being viruses. In the multivariate analysis, higher monocyte (≥0.20 vs. <0.20 × 109/L, P=0.001), higher albumin (≥30.5 vs. <30.5 g/L, P=0.044), lower lactic dehydrogenase (<250 vs. ≥250 U/L, P=0.008) and lower blood urea nitrogen (<7.2 vs. ≥7.2 mmol/L, P=0.026) levels at the onset of LOSP were significantly associated with better 60-day survival. A risk score system based on the above results showed that the probability of 60-day survival decreased with increasing risk factors and were 96.3% (low-risk group), 49.1% (intermediate-risk group) and 12.5% (high-risk group). CONCLUSIONS The results indicated that the scoring system used 4 variables could stratify patients with different probabilities of survival after LOSP, which suggested patients' immune, nutritional and metabolic status were crucial for outcome.