Marta Stanzani1, Nicola Vianelli1, Michele Cavo1, Dimitrios P Kontoyiannis2, Russell E Lewis3. 1. Institute of Haematology, Department of Haematology and Clinical Oncology "Lorenzo e Ariosto Seràgnoli" S'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 2. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States. 3. Clinic of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: russeledward.lewis@unibo.it.
Abstract
OBJECTIVE: Our objective was to develop a model that predicts a patient's risk of developing invasive mould disease (IMD) within 60 days of admission for treatment of a haematological malignancy. METHODS: We analysed 19 risk factors for IMD in a cohort of 1944 adult patients with haematological malignancies over 4127 admissions at a haematology referral centre in Northern Italy (2007-2016). We used a multivariable logistic regression to estimate the 60-day probability of developing probable or proven IMD. The model was internally validated using a bootstrap resampling procedure. RESULTS: The prevalence of IMD was 3.3% (90 probable cases, 43 proven cases). Seven risk factors were retained in the final risk model: (1) uncontrolled malignancy, (2) high-risk chemotherapy regimen, (3) high-dose corticosteroids, (4) severe lymphopenia, (5) CMV reactivation or disease, (6) prolonged neutropenia, and (7) a history of previous IMD within 90 days. The model displayed good calibration and discrimination in both the derivation (aROC 0.85, 95% CI 0.84-0.86) and validation (aROC 0.83 95% CI 0.79-0.89) populations. CONCLUSIONS: Our model differentiated with 85% accuracy whether or not patients developed IMD within 60-days of admission. Individualized risk assessment, aided by validated prognostic models, could assist IMD management and improve antifungal stewardship.
OBJECTIVE: Our objective was to develop a model that predicts a patient's risk of developing invasive mould disease (IMD) within 60 days of admission for treatment of a haematological malignancy. METHODS: We analysed 19 risk factors for IMD in a cohort of 1944 adult patients with haematological malignancies over 4127 admissions at a haematology referral centre in Northern Italy (2007-2016). We used a multivariable logistic regression to estimate the 60-day probability of developing probable or proven IMD. The model was internally validated using a bootstrap resampling procedure. RESULTS: The prevalence of IMD was 3.3% (90 probable cases, 43 proven cases). Seven risk factors were retained in the final risk model: (1) uncontrolled malignancy, (2) high-risk chemotherapy regimen, (3) high-dose corticosteroids, (4) severe lymphopenia, (5) CMV reactivation or disease, (6) prolonged neutropenia, and (7) a history of previous IMD within 90 days. The model displayed good calibration and discrimination in both the derivation (aROC 0.85, 95% CI 0.84-0.86) and validation (aROC 0.83 95% CI 0.79-0.89) populations. CONCLUSIONS: Our model differentiated with 85% accuracy whether or not patients developed IMD within 60-days of admission. Individualized risk assessment, aided by validated prognostic models, could assist IMD management and improve antifungal stewardship.
Authors: Melissa D Johnson; Russell E Lewis; Elizabeth S Dodds Ashley; Luis Ostrosky-Zeichner; Theoklis Zaoutis; George R Thompson; David R Andes; Thomas J Walsh; Peter G Pappas; Oliver A Cornely; John R Perfect; Dimitrios P Kontoyiannis Journal: J Infect Dis Date: 2020-08-05 Impact factor: 5.226
Authors: Amir Arastehfar; Agostinho Carvalho; Frank L van de Veerdonk; Jeffrey D Jenks; Philipp Koehler; Robert Krause; Oliver A Cornely; David S Perlin; Cornelia Lass-Flörl; Martin Hoenigl Journal: J Fungi (Basel) Date: 2020-06-24