Index to predict invasive mold infection in high-risk neutropenic patients based on the area over the neutrophil curve.

Full Abstract

PURPOSE: Patients with prolonged and profound neutropenia are at high risk to develop invasive mold infections (IMIs). We developed an index (D-index) that combines duration and severity of neutropenia. The aim of this study was to test the D-index as a predictor of IMI. PATIENTS AND METHODS: The D-index was based on a graph plotting the absolute neutrophil counts during neutropenia and was the area over the neutrophil curve. We tested the D-index in 11 patients with acute myeloid leukemia (AML) who developed IMI during neutropenia and 33 AML patients without IMI (controls). We also calculated a cumulative D-index (c-D-index), defined as the cumulative D-index from the start of neutropenia until the date of the first clinical manifestation of IMI in patient cases. We compared the D-index and c-D-index with duration of neutropenia and defined a cutoff for IMI using the receiver operating characteristic (ROC) curve. RESULTS: The median duration of neutropenia and profound neutropenia of patient cases were significantly higher compared with controls (P = .002 and P = .001, respectively), as were the D-index (P < .001) and c-D-index (P = .02). The D-index and c-D-index performed better than duration of neutropenia in ROC curve analysis. For a cutoff point of 5,800 of the c-D-index, the sensitivity and specificity were 91% and 58%, respectively, and for a prevalence of IMI of 5%, 10%, and 15%, the negative predictive values were 99%, 98%, and 97%, respectively. CONCLUSION: The high negative predictive value of the c-D-index may be of help in defining different risks for IMI in febrile neutropenic patients.

Author information

Author/s: Portugal, Rodrigo D (RD); Garnica, Marcia (M); Nucci, Marcio (M);

Affiliation: University Hospital, Hematology Service, Universidade Federal do Rio de Janeiro, Cidade Universitária, Rio de Janeiro, Brazil.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol), published in United States. (Language: eng)

Reference: 2009-Aug; vol 27 (issue 23) : pp 3849-54

Dates: Created 2009/08/07; Completed 2009/08/20;

PMID: 19597026, status: MEDLINE (last retrieved date: 8/21/2009)

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