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Risk factors for early mortality in haematological malignancy patients with pulmonary mucormycosis
Author(s) -
Lewis Russell E.,
Georgiadou Sarah P.,
Sampsonas Fotis,
Chamilos George,
Kontoyiannis Dimitrios P.
Publication year - 2014
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.12101
Subject(s) - medicine , proportional hazards model , hazard ratio , lymphocytopenia , gastroenterology , mortality rate , prognostic variable , surgery , multivariate analysis , lymphocyte , confidence interval
Summary Pulmonary mucormycosis (PM) is a life‐threatening opportunistic mycosis with a variable clinical evolution and few prognostic markers for outcome assessment. Several clinical risk factors for poor outcome present at the diagnosis of PM were analyzed in 75 consecutive hematology patients from 2000–2012. Significant variables ( P < 0.1) were entered into a multivariate Cox‐proportional hazard regression model adjusting for baseline APACHE II to identify independent risk factors for mortality within 28 days. Twenty‐eight of 75 patients died within 4‐week follow up. A lymphocyte count < 100/mm 3 at the time of diagnosis (adjusted hazard ratio 4.0, 1.7–9.4, P = 0.01) and high level of lactate dehydrogenase (AHR 3.7, 1.3–10.2, P = 0.015) were independent predictors along with APACHE II score for 28‐day mortality. A weighted risk score based on these 3 baseline variables accurately identified non‐surviving patients at 28 days (area under the receiver‐operator curve of 0.87, 0.77–0.93, P < 0.001). A risk score > 22 was associated with 8‐fold high rates of mortality ( P < 0.0001) within 28 days of diagnosis and median survival of 7 days versus ≥ 28 days in patients with risk scores ≤ 22. We found that APACHE II score, severe lymphocytopenia and high LDH levels at the time of PM diagnosis were independent markers for rapid disease progression and death.