Risk factors for early mortality in haematological malignancy patients with pulmonary mucormycosis

Authors

  • Russell E. Lewis,

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
    Current affiliation:
    1. Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
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    • These authors are contributed equally to this study.
  • Sarah P. Georgiadou,

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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    • These authors are contributed equally to this study.
  • Fotis Sampsonas,

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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  • George Chamilos,

    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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  • Dimitrios P. Kontoyiannis

    Corresponding author
    1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
    • Correspondence: D. P. Kontoyiannis, Department of Infectious Diseases, Infection Control and Employee Health, Unit 402, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.

      Tel.: +(713) 792 6237. Fax: +(713) 745 6839.

      E-mail: dkontoyi@mdanderson.org

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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/mm3 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 math formula28 days in patients with risk scores math formula22. 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.

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