The D-index assesses neutropenia dynamics. Prolonged neutropenia is a major risk for invasive fungal infection (IFI); we hypothesized that D-index is predictive of IFI risk. We retrospectively reviewed 789 adults who underwent allogeneic hematopoietic transplant (HSCT) from 1/1/2005 to 9/30/2015. Medical records were reviewed from transplant (D0) through Day 100. The D-index was calculated as area over the neutrophil curve until engraftment. 714 patients were included for analysis. Sixteen (2%) developed probable (11) or proven (5) IFI. Median time to IFI was 40 days (range 8-98) after HSCT. Groups with and without IFI did not differ significantly in duration of mild or profound neutropenia. Median D-index of those with IFI was 4293 days neutrophil/µl compared to 3590 days neutrophil/µl for those without IFI (P = 0.17). Patients who were neutropenic on D0 showed higher rates of IFI than those who were not (10/123 [8%] vs 6/591 [1%]; P < 0.001). Only 2% developed IFI, likely due to mold-active antifungal prophylaxis. The D-index was not significantly higher in those with IFI. Duration of profound neutropenia and neutropenia at D0 may be better markers for IFI among HSCT recipients during the first 30 and 100 days after transplant.

中文翻译：

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在异基因造血干细胞移植受者中，在植入后早期阶段，D指数与侵袭性真菌感染无关。

D指数评估中性粒细胞减少动力学。嗜中性白血球减少症是侵袭性真菌感染（IFI）的主要风险；我们假设D指数可预测IFI风险。我们回顾性回顾了从2005年1月1日到2015年9月30日接受同种异体造血移植（HSCT）的789名成人。从移植（D0）到第100天检查病历。D指数计算为中性粒细胞曲线直至植入的面积。包括714位患者进行分析。十六（2％）人开发了IFI（11）或已证实（5）。HSCT后，IFI的中位数时间为40天（范围8-98）。有和没有IFI的组在轻度或中性白细胞减少症的持续时间上没有显着差异。患有IFI的患者中位数D指数为4293天中性粒细胞/微升，而没有IFI的患者中位数D指数为3590天中性粒细胞/微升（P = 0.17）。D0发生中性粒细胞减少的患者的IFI发生率高于未接受中性粒细胞减少的患者（10/123 [8％]对6/591 [1％]； P <0.001）。只有2％的人发展了IFI，这很可能是由于霉菌活性抗真菌药的预防。DFI指数在IFI患者中没有显着升高。在移植后的前30天和100天，深层中性粒细胞减少和D0期中性粒细胞减少的持续时间可能是HSCT接受者中IFI的更好标志。