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Predicting mortality from intracranial hemorrhage in patients who undergo allogeneic hematopoietic stem cell transplantation

Intracranial hemorrhage (ICH) is a rare but fatal central nervous system complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, factors that are predictive of early mortality in patients who develop ICH after undergoing allo-HSCT have not been systemically investiga...

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Detalles Bibliográficos
Autores principales: Ren, Xiying, Huang, Qiusha, Qu, Qingyuan, Cai, Xuan, Fu, Haixia, Mo, Xiaodong, Wang, Yu, Zheng, Yawei, Jiang, Erlie, Ye, Yishan, Luo, Yi, Chen, Shaozhen, Yang, Ting, Zhang, Yuanyuan, Han, Wei, Tang, Feifei, Mo, Wenjian, Wang, Shunqing, Li, Fei, Liu, Daihong, Zhang, Xiaoying, Zhang, Yicheng, Feng, Shuqing, Gao, Feng, Yuan, Hailong, Wang, Dao, Wan, Dingming, Chen, Huan, Chen, Yao, Wang, Jingzhi, Chen, Yuhong, Wang, Ying, Xu, Kailin, Lang, Tao, Wang, Xiaomin, Meng, Hongbin, Li, Limin, Wang, Zhiguo, Fan, Yanling, Chang, Yingjun, Xu, Lanping, Huang, Xiaojun, Zhang, Xiaohui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Hematology 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9153001/
https://www.ncbi.nlm.nih.gov/pubmed/34448835
http://dx.doi.org/10.1182/bloodadvances.2021004349
Descripción
Sumario:Intracranial hemorrhage (ICH) is a rare but fatal central nervous system complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, factors that are predictive of early mortality in patients who develop ICH after undergoing allo-HSCT have not been systemically investigated. From January 2008 to June 2020, a total of 70 allo-HSCT patients with an ICH diagnosis formed the derivation cohort. Forty-one allo-HSCT patients with an ICH diagnosis were collected from 12 other medical centers during the same period, and they comprised the external validation cohort. These 2 cohorts were used to develop and validate a grading scale that enables the prediction of 30-day mortality from ICH in all-HSCT patients. Four predictors (lactate dehydrogenase level, albumin level, white blood cell count, and disease status) were retained in the multivariable logistic regression model, and a simplified grading scale (termed the LAWS score) was developed. The LAWS score was adequately calibrated (Hosmer-Lemeshow test, P > .05) in both cohorts. It had good discrimination power in both the derivation cohort (C-statistic, 0.859; 95% confidence interval, 0.776-0.945) and the external validation cohort (C-statistic, 0.795; 95% confidence interval, 0.645-0.945). The LAWS score is the first scoring system capable of predicting 30-day mortality from ICH in allo-HSCT patients. It showed good performance in identifying allo-HSCT patients at increased risk of early mortality after ICH diagnosis. We anticipate that it would help risk stratify allo-HSCT patients with ICH and facilitate future studies on developing individualized and novel interventions for patients within different LAWS risk groups.