当前位置: X-MOL 学术Ann. Hematol. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Serum albumin and C-reactive protein as significant predictors of non-relapse mortality in lower gastrointestinal graft-versus-host disease.
Annals of Hematology ( IF 3.5 ) Pub Date : 2020-04-06 , DOI: 10.1007/s00277-020-04015-4
Haerim Chung 1 , Ji Eun Jang 1 , Soo-Jeong Kim 1 , Jin Seok Kim 1 , Yoo Hong Min 1 , June-Won Cheong 1
Affiliation  

Acute graft-versus-host disease (aGVHD) of the lower gastrointestinal (GI) tract is the major cause of non-relapse mortality (NRM) in allogeneic hematopoietic stem cell transplantation (alloHSCT). This study aimed to identify variables associated with corticosteroid response and NRM in patients who developed lower GI aGVHD. We retrospectively analyzed the clinical data of patients treated at Yonsei University Severance Hospital between 2008 and 2017. Among 244 recipients of alloHSCT, 48 (19.7%) were diagnosed as lower GI aGVHD at a median of 22 days after alloHSCT. In these cases, 20 (41.6%) patients were resistant to corticosteroid therapy. Corticosteroid resistance was associated with advanced stage of lower GI aGVHD (P = 0.019), low serum albumin (P = 0.006), and elevated CRP (P = 0.030) on day 7 after corticosteroid therapy. NRM rate was significantly higher in the corticosteroid-resistant group compared with the sensitive group (HR 5.339, P = 0.003). Multivariate analysis revealed serum albumin (P = 0.046), and CRP levels (P = 0.032) were independent prognostic factors for NRM. When the patients were classified into 3 groups according to Glasgow prognostic score (GPS), the rate of corticosteroid resistance was significantly higher in the high GPS group compared with the intermediate or low GPS group (83.3 vs. 27.2 and 15.3%, respectively, P < 0.001). We demonstrated that low serum albumin and elevated CRP level on day 7 after corticosteroid therapy are objective biomarkers of corticosteroid resistance and a significant predictor for higher NRM. These simple and practical parameters could be valuable information predicting response and prognosis in lower GI aGVHD.

中文翻译:

血清白蛋白和C反应蛋白是下消化道移植物抗宿主病非复发死亡率的重要预测指标。

下消化道(GI)的急性移植物抗宿主病(aGVHD)是异基因造血干细胞移植(alloHSCT)中非复发死亡率(NRM)的主要原因。这项研究的目的是确定患有较低GI aGVHD的患者中与糖皮质激素反应和NRM相关的变量。我们回顾性分析了2008年至2017年在延世大学遣散医院接受治疗的患者的临床数据。在244名alloHSCT接受者中,有48名(19.7%)在alloHSCT后中位数被诊断为低GI aGVHD。在这些情况下,有20名(41.6%)患者对皮质类固醇激素治疗有抵抗力。皮质类固醇治疗后第7天,皮质类固醇耐药与晚期GI aGVHD(P = 0.019),血清白蛋白低(P = 0.006)和CRP升高(P = 0.030)晚期有关。糖皮质激素抵抗组的NRM发生率明显高于敏感组(HR 5.339,P = 0.003)。多变量分析显示血清白蛋白(P = 0.046)和CRP水平(P = 0.032)是NRM的独立预后因素。根据格拉斯哥预后评分(GPS)将患者分为3组时,高GPS组的皮质类固醇抵抗率显着高于中或低GPS组(分别为83.3%和27.2%和15.3%,P <0.001)。我们证明皮质类固醇治疗后第7天血清白蛋白低和CRP水平升高是皮质类固醇抵抗的客观生物标志物,并且是较高NRM的重要预测因子。这些简单而实用的参数可能是预测较低GI aGVHD患者反应和预后的有价值的信息。
更新日期:2020-04-20
down
wechat
bug