scholarly journals Clinical Characteristics, Risk Factors and Antiviral Treatments of Influenza in Immunosuppressed Inpatients in Beijing During the 2015-2020 Influenza Seasons

2021 ◽  
Author(s):  
Yafen Liu ◽  
Yue Wang ◽  
Huan Mai ◽  
YuanYuan Chen ◽  
Baiyi Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Influenza Virus ◽  
Influenza Vaccination ◽  
Mental Status ◽  
Clinical Characteristics ◽  
Antiviral Treatment ◽  
Univariate Analysis ◽  
Altered Mental Status ◽  
Hematopoietic Stem ◽  
Immunosuppressed Patients

Abstract Background Influenza infection was a vital threat to immunosuppressed patients with longer viral shedding; however, data on these populations in China are still lacking. We analyzed clinical characteristics, risk factors and effects of antiviral therapy in these populations. Methods We analyzed 111 immunosuppressed inpatients tested positive for influenza virus using RT-PCR during the 2015–2020 influenza seasons. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results The most common immunosuppression type was malignancies with chemotherapy 87.4% (97/111), then hematopoietic stem cell transplantation 23.4% (26/111). The most common presenting symptom was fever in 92.8% (103/111) patients, then cough 50.6% (44/87). 14.4% (16/111) patients were admitted to ICU and 9.9% (11/111) patients died. Combination and double dose of neuraminidase inhibitors did not significantly reduce the admission to ICU and death. Risk factors for admission to ICU were dyspnea, co-infection with other infections and no antiviral treatment within 48 hours, and presence of dyspnea and altered mental status were independently associated with death through multivariate logistics analysis. Seasonal influenza vaccination in preceding 12 months only took up 2.7% (3/111). Conclusion Fever and other classical symptoms of influenza may be absent in immunosuppressed recipients, and conducting influenza virus detection at the first time is a good choice for early diagnosis. Immunosuppressed patients with dyspnea, altered mental status, co-infection with other infections and no antiviral treatment within 48 hours are of note needed, because these people have high-risk to severe cases. Inactivated influenza vaccination should be taken into account in immunosuppressed patients.

scholarly journals Clinical characteristics, risk factors and antiviral treatments of influenza in immunosuppressed inpatients in Beijing during the 2015–2020 influenza seasons

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Yafen Liu ◽  
Yue Wang ◽  
Huan Mai ◽  
YuanYuan Chen ◽  
Baiyi Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Influenza Virus ◽  
Mental Status ◽  
Clinical Characteristics ◽  
Antiviral Treatment ◽  
Altered Mental Status ◽  
Haematopoietic Stem Cell ◽  
Severe Illness ◽  
Presenting Symptoms ◽  
Immunosuppressed Patients

Abstract Background Compared with immunocompetent patients, immunosuppressed patients have higher morbidity and mortality, a longer duration of viral shedding, more frequent complications, and more antiviral resistance during influenza infections. However, few data on this population in China have been reported. We analysed the clinical characteristics, effects of antiviral therapy, and risk factors for admission to the intensive care unit (ICU) and death in this population after influenza infections and explored the influenza vaccination situation for this population. Methods We analysed 111 immunosuppressed inpatients who were infected with influenza virus during the 2015–2020 influenza seasons. Medical data were collected through the electronic medical record system and analysed. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results The most common cause of immunosuppression was malignancies being treated with chemotherapy (64.0%, 71/111), followed by haematopoietic stem cell transplantation (HSCT) (23.4%, 26/111). The most common presenting symptoms were fever and cough. Dyspnoea, gastrointestinal symptoms and altered mental status were more common in HSCT patients than in patients with immunosuppression due to other causes. Approximately 14.4% (16/111) of patients were admitted to the ICU, and 9.9% (11/111) of patients died. Combined and double doses of neuraminidase inhibitors did not significantly reduce the risk of admission to the ICU or death. Risk factors for admission to the ICU were dyspnoea, coinfection with other pathogens and no antiviral treatment within 48 h. The presence of dyspnoea and altered mental status were independently associated with death. Only 2.7% (3/111) of patients less than 12 months old had received a seasonal influenza vaccine. Conclusion Fever and other classic symptoms of influenza may be absent in immunosuppressed recipients, especially in HSCT patients. Conducting influenza virus detection at the first presentation seems to be a good choice for early diagnosis. Clinicians should pay extra attention to immunosuppressed patients with dyspnoea, altered mental status, coinfection with other pathogens and no antiviral treatment within 48 h because these patients have a high risk of severe illness. Inactivated influenza vaccines are recommended for immunosuppressed patients.

scholarly journals Influenza infection in immunosuppressed patients: clinical characteristics, risk factors and effect of antiviral therapy

2020 ◽  
Author(s):  
YaFen Liu ◽  
Yue Wang ◽  
YuanYuan Chen ◽  
BaiYi Liu ◽  
YiSi Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Influenza Virus ◽  
Influenza Vaccination ◽  
Symptom Onset ◽  
Clinical Characteristics ◽  
Influenza Infection ◽  
Antiviral Treatment ◽  
Double Dose ◽  
Neuraminidase Inhibitors ◽  
Immunosuppressed Patients

Abstract Background: Influenza infection was a vital threat to immunosuppressed patients with longer viral shedding; however, data on these populations in China are still lacking. We analyzed clinical characteristics, risk factors for admission to intensive care unit (ICU) and death, and effect of antiviral therapy in these populations.Methods: We analyzed 73 immunosuppressed inpatients tested positive for influenza virus using reverse-transcription polymerase chain reaction during the 2018-2019 influenza season. Medical data were analyzed using descriptive statistics. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results: The most common immunosuppression type was malignancies with chemotherapy 73.9% (54/73), then hematopoietic stem cell transplantation 19.2% (14/73). The most common presenting symptom was fever in 91.8% (67/73) patients, then cough 59.6% (34/57) and muscular soreness 35.1% (20/57). Complications and co-infections were found in 38.4% (28/73) and 17.8% (13/73) patients respectively, which significantly prolonged the hospital stay. Antiviral treatment after 48 hours was significantly associated with admission to ICU, mechanical ventilation and death. Combination and double dose of neuraminidase inhibitors did not significantly reduce the admission to ICU and death. 15.1% (11/73) patients were admitted to ICU and 8.2% (6/73) patients died. Risk factors for admission to ICU were long symptom onset (OR 5.60, P=0.018) and co-infection with other infections (OR 68.66, P=0.019), and presence of dyspnea was independently associated with death (OR 48.00, P=0.003) through multivariate logistics analysis. Seasonal influenza vaccination in preceding 12 months only took up 2.7% (2/73).Conclusion: Fever and other classical symptoms may be absent in immunosuppressed recipients, and conducting influenza virus detection at the first time is a good choice for early diagnosis. Antiviral treatment within 48 hours is of significance; however, patients may not benefit from combination and double dose of neuraminidase inhibitors. Immunosuppressed patients with dyspnea, long symptom onset and co-infection with other infections are of note needed, because these people have high-risk to severe cases. Inactivated influenza vaccination should be taken into account in immunosuppressed patients.

scholarly journals Predictive factors of posttreatment fracture by definitive radiotherapy for uterine cervical cancer

2020 ◽  
Author(s):  
Kazuki Ishikawa ◽  
Tsuneo Yamashiro ◽  
Takuro Ariga ◽  
Takafumi Toita ◽  
Wataru Kudaka ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Cervical Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Clinical Characteristics ◽  
Univariate Analysis ◽  
Uterine Cervical Cancer

Abstract Purpose Fractures are known to shorten life expectancy and worsen the quality of life. The risk of fractures after radiation therapy in cervical cancer patients is known to be multifactorial. In this study, we examined risk factors for fractures in cervical cancer patients, especially by evaluating bone densities and DVH parameters for fractured bones. Materials and Methods For 42 patients, clinical characteristics, pretreatment CT bone densities, and radiation dose were compared between patients with and without fractures. Results Posttreatment fractures occurred in 25 bones among ten patients. Pretreatment CT bone densities were significantly lower in patients with fractures (P < 0.05–0.01 across sites, except for the ilium and the ischium). Although DVH parameters were also significantly associated with fractures in univariate analysis, only CT densities were significantly associated with fractures in multivariate analysis. Conclusion Pretreatment CT densities of spinal and pelvic bones, which may reflect osteoporosis, have a significant impact on the risk for posttreatment fractures.

Clinical characteristics, evolution, and treatment-related risk factors for mortality among immunosuppressed patients with influenza A (H1N1) virus admitted to the intensive care unit

2018 ◽  
Vol 48 ◽  
pp. 172-177 ◽  
Author(s):  
José Garnacho-Montero ◽  
Cristina León-Moya ◽  
Antonio Gutiérrez-Pizarraya ◽  
Angel Arenzana-Seisdedos ◽  
Loreto Vidaur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Influenza A ◽  
Clinical Characteristics ◽  
H1n1 Virus ◽  
Related Risk ◽  
Influenza A H1n1 ◽  
Immunosuppressed Patients

Non-Myeloablative Hematopoietic Stem Cell Transplantation in Older Patients with AML and MDS: Results from the Center for International Blood and Marrow Transplant Research (CIBMTR)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 346-346 ◽  
Author(s):  
Brian McClune ◽  
Daniel J. Weisdorf ◽  
John F. DiPersio ◽  
Armand Keating ◽  
Tanya L. Pedersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Complete Remission ◽  
Cell Transplantation ◽  
Older Patients ◽  
Univariate Analysis ◽  
Hematopoietic Stem ◽  
Age Cohorts ◽  
Allogeneic Hct ◽  
First Complete Remission

Abstract Background: AML and MDS disproportionately affect older-aged individuals. Hematopoietic cell transplantation (HCT) is the best established curative therapy but is generally not offered due to concerns about toxicity and poor outcome. Reduced-intensity conditioning (RIC) regimens have been developed to allow allografting in older patients; however, there is a paucity of data to support transplantation in patients over 65 years of age. Purpose: To better study age as a predictor of outcome, we retrospectively analyzed data reported to the CIBMTR from 1995–2005 among patients receiving RIC HCT for MDS (551 patients) and AML (565 patients) in first complete remission (CR). Patient and Methods: Outcomes analyzed for both disease groups included transplant-related mortality (TRM), engraftment, incidence of acute and chronic graft-versus-host disease (GVHD), leukemia-free (LFS) and overall survival (OS). Patients were stratified according to age cohorts for comparison: 40–54, 54–59, 60–64 and ≥65 years. Results: Clinical characteristics were well matched across age cohorts but notably, most AML patients presented with de novo disease (P=0.001) and received their allograft from a matched related donor (MRD) (P=0.001) with 51% of patients ≥65 years having a MRD. MDS patients more often had unrelated donors (URD), especially in the older cohorts (73% for ≥ 65 years); but donor type was not significantly different between groups. Most patients received peripheral blood (PB) allografts (76–97%), fludarabine-containing regimens for conditioning and cyclosporine-containing regimens for GVHD prophylaxis. Univariate analysis demonstrated no statistically significant differences in TRM across age cohorts and no overall difference in occurrence of acute (31–35% at 100 days) or chronic GVHD (36–53% at 2 years). Relapse rates were similar across all age groups (29–39% at 3 years) (Table). Multivariate analysis revealed no statistically significant impact of age on TRM, relapse, LFS, or OS (all p &gt; 0.4). Disease and status at transplant were significant risk factors for OS/LFS at 1 year while affecting TRM/relapse at 2 years. Performance status and HLA disparity were also significant at 2 years for nearly all outcomes. Conclusion: 1. The outcomes for older adults undergoing allogeneic HCT are not significantly different than for younger adults, even after adjusting for multiple risk factors; 2. Age by itself should not be the limiting factor for proceeding to allogeneic HCT in older patients with AML or MDS; 3. Continued participation in clinical trials should be encouraged to explore strategies that could improve treatment outcome. Univariate probabilities of patients age ≥40 years receiving allogeneic HCT for AML/MDS in first complete remission reported to the CIBMTR, 1995–2005. N 40–54 N 55–60 N 60–64 N &gt;65 AML TRM 220 150 132 63 100 days 11 (7–16)% 6 (3–10)% 13 (8–20)% 10 (4–18)% 1 year 20 (15–26)% 18 (12–24)% 24 (17–33)% 30 (19–42)% Relapse 1 year 27 (21–33)% 34 (26–42)% 31 (23–40)% 22 (12–33)% 3 years 32 (26–39)% 35 (27–43)% 39 (30–49)% 33 (21–46)% LFS 1 year 53 (46–60)% 49 (41–58)% 44 (35–53)% 48 (36–61)% 3 years 43 (36–51)% 41 (32–50)% 27 (19–37)% 34 (22–47)% OS 100 days 84 (78–88)% 92 (87–96)% 83 (76–89)% 89 (80–95)% 1 year 59 (52–65)% 60 (52–68)% 51 (42–60)% 51 (39–64)% 3 years 45 (40–54)% 47 (42–59)% 30 (25–43)% 36(24–49)% Follow-up (months) 37 (2–110) 25 (1–87) 36 (3–96) 29 (3–59) MDS TRM 219 150 127 55 100 days 17 (13–23)% 17 (11–23)% 14 (9–21)% 19 (9–30)% 1 year 31 (24–37)% 33 (25–41)% 32 (24–41)% 34 (22–47)% Relapse 1 year 26 (20–32)% 27 (20–35)% 26 (18–34)% 25 (14–37)% 3 years 29 (23–35)% 29 (22–37)% 31 (23–40)% higher 33 (20–47)% LFS 1 year 43 (36–50)% 40 (32–49)% 43 (34–51)% 42 (29–56)% 3 years 36 (29–43)% 27 (–2035)% 29 (21–39)% 23 (12–38)% OS 100 days 77 (71–82)% 77 (70–83)% 81 (74–87)% 76 (64–87)% 1 year 50 (43–56)% 46 (38–54)% 53 (44–62)% 48 (35–61)% 3 years 39 (32–46)% 29 (22–37)% 30 (21–40)% 29 (17–43)% Follow-up (months) 36 (2–86) 40 (3–86) 35 (3–68) 36 (3–85)

A Prognostic Score For Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3389-3389
Author(s):  
Bernd Gruhn ◽  
Ilona Wolff ◽  
James F. Beck ◽  
Clemens Arndt
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Myeloid Leukemia ◽  
Disease Risk ◽  
Univariate Analysis ◽  
Peripheral Blood Stem Cells ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Blood Stem Cells

Abstract Background The effects of certain risk factors on the survival of adults undergoing allogeneic hematopoietic stem cell transplantation (HSCT) have been the subject of research for many years. The impact of graft source and donor type, for instance, has already been examined closely. Lately iron parameters like ferritin became point of interest. Several prognostic scores utilizing those risk factors have been proposed. However, observations of pediatric populations considering those factors remain rare and no score in this regard for children with HSCT is available yet. Methods We retrospectively analyzed the effects of patient sex, recipient-donor sex match status, patient age, donor age, disease risk, graft source, donor HLA match as well as ferritin, albumin, total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), cholinesterase (CHE), gamma glutamyl transpeptidase (GGT), C-reactive protein (CRP) and lactate dehydrogenase (LDH) taken at the time of transplantation on the 5-year-overall survival of 132 children with malignant or non-malignant diseases undergoing allogeneic HSCT between 2001 and 2011 in a single center. The graft source was either bone marrow (n=82) or peripheral blood stem cells (n=50). The patients had the following underlying diseases: acute lymphoblastic leukemia (n=44), acute myeloid leukemia (n=29), chronic myeloid leukemia (n=5), myelodysplastic syndrome (n=16), non-Hodgkin lymphoma (n=7), solid tumor (n=4), severe aplastic anemia (n=7), myelofibrosis (n=2) and genetic disease (n=18). Conditioning regimen was myeloablative in all cases. The disease risk was formed by dividing the patients into two groups according to their clinical risk. Patients with genetic diseases, severe aplastic anemia, refractory cytopenia, myelofibrosis, leukemia and lymphoma in first or second remission as well as chronic myeloid leukemia in chronic phase were low risk, while patients with solid tumors, leukemia and lymphoma in relapse or in more than second remission and refractory anemia with excess blast in or not in transformation were high risk. For statistics we used Kaplan-Meier-method for univariate analysis and Cox regression for multivariate analysis. Results On univariate analysis 5-year-overall survival decreased significantly in patients with ferritin >1500 µg/L (40.8% versus 78.8%, p<0.001), GGT >1 µmol/L∙s (43.2% versus 67.9%, p=0.032), CRP >10 mg/L (54.6% versus 69.4%, p=0.017), LDH >6 µmol/L∙s (22.2% versus 66.8%, p=0.001), CHE <60 µmol/L∙s (35.7% versus 70%, p=0.002) as well as in patients with high disease risk (38.3% versus 74.7%, p<0.001), peripheral blood stem cells as graft source (47.1% versus 72.2% for bone marrow, p=0.001). For HLA donor match there was a 5-year-overall survival of 82.0% for matched related, 58.4% for matched unrelated, 56.3% for mismatched unrelated and 50.0% for haploidentical related donors (p=0.020). Other factors did not show a significant correlation. We subsequently developed a score of those parameters that were significant in multivariate analysis, i.e. disease risk (HR=3.744, p=0.035), ferritin (HR=6.860, p=0.002) and cholinesterase (HR=4.556, p=0.043), dividing the patient population into three groups: low with no risk factor, intermediate with one risk factor and high with two or three risk factors. For this score we found a 5-year-overall survival of 92.3% for low risk group, 66.2% for intermediate risk and 17.4% for high risk (p<0.001). Conclusion Our data show that ferritin, cholinesterase and disease risk are factors that decisively influence the prognosis after allogeneic HSCT in children. They should be evaluated in further trials as well as our proposed score. The characteristics that showed up significant in univariate but not in multivariate analysis appear to have an influence as well and might show a stronger correlation in larger trials. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Study in the Clinical Characteristics of Stenotrophomonas Maltophilia Bacteremia in Hematological Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4631-4631
Author(s):  
Haiyan Bao ◽  
Jia Chen ◽  
Xiaojin Wu ◽  
Xiao Ma ◽  
Chengcheng Fu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Respiratory Failure ◽  
Stenotrophomonas Maltophilia ◽  
Clinical Characteristics ◽  
Univariate Analysis ◽  
P Value ◽  
Hematological Diseases ◽  
Factors Associated

Abstract Introduction: Stenotrophomonas maltophilia is an important nosocomial pathogen, particularly in immunocompromised patients, especially in patients with hematologic diseases. Methods: We reviewed the clinical characteristics and prognosis of patients with S. maltophilia bacteremia over a five-year period from January 2010 to December 2014. Species identification was performed using the automated Vitek 2 compact system (bioMe rieux). Results: The incidence of S. maltophilia bacteremia was 25.1 per 10 000 admissions in our study. Thirty-four patients (median age: 34 years; 64.7% males) with S. maltophilia bacteremia were analyzed. The S. maltophilia bacteremia related 30-day mortality was 44.1%. Risk factors associated with mortality in patients with S. maltophilia infection in the univariate and multivariate analysis were represented in Tables I and II. In the univariate analysis, risk factors included T>39.0¡æ, septic shock, respiratory failure and non-remission after treatment for primary hematological diseases (P <0.05). In the multivariate analysis, respiratory failure and non-remission status after treatment forhematological diseases were independent prognostic factors for mortality. In vitro susceptibility was higher to ciprofloxacin(82.4%), ceftazidime(70.6%), sulbactam and cefoperazone(58.8%), which was shown in Table III. Conclusion: Combination regimens with ciprofloxacin and ceftazidime, or sulbactam and cefoperazone could be alternative treatment. Novel antibiotics are required for treatment of S. maltophilia infection, as well as infection control practices of environmental reserves, rapid detection of pathogens, risk stratification strategy and appropriate treatment for primary hematologic malignancies, which might conjointly contribute to better survival outcome of S. maltophilia bacteremia. Univariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Table 1. Factor Mortality HR 95%CI P-value Withfactor Withoutfactor T>39.0¡æ 75% 16.7% 2.490 1.318-4.704 0.005 Septic shock 90.0% 25.0% 2.544 1.473-4.393 0.001 Respiratory failure 100% 20.8% 4.672 2.366-9.225 0.000 Treatment outcome for hematological diseases Remission 10.0% 85.7% 0.247 0.116-0.526 0.000 HR, hazard ratio; CI, confidence interval; HSCT, Hematopoietic stem cell transplantation Table 2. Multivariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Factor HR 95%CI P-value Respiratory failure 2.688 1.297-5.569 0.008 Remission after treatment for hematological diseases 0.367 0.153-0.879 0.025 HR, hazard ratio; CI, confidence interval Table 3. Susceptibility pattern of the 34 patients with Stenotrophomonas maltophilia bacteremia Antimicrobial agents S (%) I (%) Ceftazidime 24(70.6%) 1(2.9%) Cefoperazone 19(44.1%) 6(17.6%) Sulbactam and Cefoperazone 20(58.8%) 5(14.7%) Piperacillin 7(20.6%) 6(17.6%) Piperacillin-Tazobactam 11(32.3%) 7(20.6%) Amikacin 6(17.6%) 0(0%) Ciprofloxacin 28(82.4%) 1(2.9%) S, susceptible; I, intermediately susceptible. Disclosures No relevant conflicts of interest to declare.

scholarly journals Analysis of Risk Factors for Hepatic Sinusoidal Obstruction Syndrome Following Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients

2021 ◽  
Author(s):  
Jaspar Kloehn ◽  
Grit Brodt ◽  
Jana Ernst ◽  
Bernd Gruhn
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Gemtuzumab Ozogamicin ◽  
Sinusoidal Obstruction Syndrome ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct

Abstract Purpose Hepatic sinusoidal obstruction syndrome (SOS), which is also known as veno-occlusive disease of the liver, represents a serious complication following hematopoietic stem cell transplantation (HSCT). Our study aimed to investigate important risk factors for SOS in a pediatric population. Methods This retrospective study analyzed 105 children who underwent allogeneic HSCT at our pediatric HSCT center in Jena. The observation period was 12 years and SOS was defined by the modified pediatric Seattle criteria up to day +30 after HSCT. Results 15 out of all 105 patients developed SOS (14.3%). The median time from HSCT to SOS diagnosis was 12 days. The mortality rate of SOS was only 20.0%. In univariate analysis, we identified the significant risk factors of a patient age < 1 year (odds ratio (OR) = 7.25, p = 0.037) and a prior treatment with gemtuzumab ozogamicin (OR = 11.00, p = 0.020). In addition, some laboratory values, which were taken before HSCT, had a significant association to SOS. Ferritin > 1500 ng/mL (OR = 4.00, p = 0.033), ferritin > 2000 ng/mL (OR = 4.69, p = 0.016), ferritin > 2400 ng/mL (OR = 5.29, p = 0.005) and the international normalized ratio (INR) ≥ 1.3 (OR = 5.91, p = 0.009) showed significant results in univariate analysis. The following risk factors could be confirmed in multivariate analysis: prior treatment with gemtuzumab ozogamicin (OR = 9.24, p = 0.048), ferritin > 2400 ng/mL (OR = 5.74, p = 0.023) and INR ≥ 1.3 (OR = 8.02, p = 0.007).Conclusion Our study confirms several risk factors for hepatic SOS following allogeneic HSCT in pediatric patients. In addition, we report for the first time a significant association between high INR before HSCT and hepatic SOS, which consequently could improve the SOS risk evaluation.

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