实体癌粒缺乏伴发热发生严重不良事件的危险因素分析及风险预测

Risk factors analysis and risk prediction of severe adverse events in solid cancer patients with febrile neutropenia

摘要:

目的 分析粒细胞缺乏伴发热（febrile neutropenia，FN）的实体癌患者发生严重不良事件（serious adverse events，SAE）的危险因素，并对稳定发热性中性粒细胞减少症临床指数（clinical index of stable febrile neutropenia，CISNE）与多国癌症支持治疗协会（Multinational Association of Supportive Care in Cancer，MASCC）风险分层模型的预测效能进行比较。方法 回顾性收集2016年1月至2021年6月重庆大学附属肿瘤医院诊治的所有经化疗后发生FN的实体癌患者。将患者分为SAE组和非SAE组，SAE的定义：①FN治疗期间出现感染性休克或脏器功能衰竭且必需转入ICU治疗；②FN发生后60 d内死亡。比较2组临床资料，采用二元logistic回归分析SAE的独立危险因素。计算患者CISNE评分和MASCC评分，比较CISNE、MASCC评分识别低危FN的效能。结果 共入选91例患者，其中SAE 18例（19.78%）。二元logistic回归分析发现SAE的独立危险因素为：ECOG评分≥2分、血钾<3.5 mmol/L、降钙素原（procalcitonin，PCT）≥0.5 ng/mL和单核细胞计数≤0.02×10⁹个/L（OR=8.619、11.358、30.612、11.202，95%CI=1.124～66.094、1.696～76.047、5.013～186.947、1.889～66.440，P<0.05）。SAE组与非SAE组的CISNE、MASCC评分均具有统计学差异（P<0.05）。CISNE 0分（低危）与MASCC评分≥21分（低危）患者SAE的发生率明显低于非低危组（P<0.05）。CISNE 0分与MASCC≥21分识别低危FN的敏感性、特异性、阳性和阴性预测值分别为21.9%、100.0%、100.0%、24.0%和91.8%、38.9%、85.9%、53.8%。结论 ECOG评分≥2分、血钾<3.5 mmol/L、PCT≥0.5 ng/mL和单核细胞计数≤0.02×10⁹个/L是FN患者发生SAE的独立危险因素。CISNE 0分比MASCC≥21分预测低危FN的特异性和阳性预测值更高。

Abstract:

Objective To analyze the risk factors of serious adverse events（SAE）in solid cancer patients with febrile neutropenia（FN），and to compare the predictive efficacy of the clinical index of stable febrile neutropenia（CISNE） and the risk stratification model of Multinational Association of Supportive Care in Cancer（MASCC）.Methods The clinical data of solid cancer patients with FN after chemotherapy from January 2016 to June 2021 in Chongqing University Cancer Hospital were retrospectively collected. The patients were divided into the SAE group and the non-SAE group. The definition of SAE was as follows：①septic shock or other organ failure and necessary transfer to ICU during FN treatment；②or death within 60 days after FN. The clinical data of the two groups were compared，the binary logistic regression analysis was performed to obtain the independent risk factors of SAE，and the patients' CISNE and MASCC scores were calculated to compare the efficacy of CISNE and MASCC scores in identifying low-risk FN.Results A total of 91 patients were enrolled，including 18（19.78%）patients with SAE. The binary logistic regression analysis showed that the independent risk factors of SAE were as follows： ECOG score≥2 points，serum potassium<3.5 mmol/L，procalcitonin（PCT）≥ 0.5 ng/mL，and monocyte count ≤ 0.02×10⁹/L（OR=8.619，11.358，30.612，11.202；95%CI=1.124-66.094，1.696-76.047，5.013-186.947，1.889-66.440，P<0.05）. There were statistical differences in CISNE and MASCC scores between the SAE group and the non-SAE group（P<0.05）. The incidences of SAE in patients with CISNE score=0 point（low risk）and MASCC score≥21 points（low risk） were significantly lower than those in the non-low risk group（P<0.05）. The sensitivity，specificity，positive and negative predictive values of CISNE score=0 point and MASCC score≥21 points for identifying low-risk FN were 21.9%，100.0%，100.0%，24.0% and 91.8%，38.9%，85.9%，53.8%，respectively.Conclusion ECOG score≥2 points，serum potassium<3.5 mmol/L，PCT≥0.5 ng/mL，and monocyte count ≤ 0.02×10⁹/L are independent risk factors of SAE in solid cancer patients with FN. CISNE score=0 point has higher specificity and positive predictive value than MASCC ≥21 points in predicting low-risk FN.