C-Reactive Protein on Admission Predicts Transplant-Related Mortality in Recipients of Allogeneic Stem Cell Transplant.
Notice bibliographique
Résumé
Abstract The C-reactive protein (CRP) is an acute phase protein that is released in response to inflammatory cytokines. An early increase in CRP following allogeneic and autologous stem cell transplant (SCT) has been shown to correlate with major transplant complications and transplant-related mortality (TRM). To date, there are no published reports documenting the impact of CRP levels prior to conditioning on outcomes after an allogeneic SCT. We thus collected pre-conditioning (PC) CRP data on 475 consecutive adult patients (>16 years of age) who received a first myeloablative allogeneic SCT for chronic myeloid (n=391) or acute leukemia (n=84) between January 1989 and October 2006. There were 228 sibling and 247 matched unrelated donors. CRP data were collected at a median of 16 days prior to stem cell infusion and were divided into 3 groups: < 2 mg/L (low, n=153), 2–9 mg/L (intermediate, n=239) and > 9 mg/L (high, n=83). Values > 9 mg/L are considered abnormal whereas values < 9mg/L are usually regarded as clinically insignificant. In univariate analysis, the 5 year probabilities of survival were 69% (low), 58% (intermediate) and 30% (high). When adjusted for patient age, disease stage, duration of disease prior to transplant, donor type (sibling versus unrelated), patient/donor sex and treatment era in a Cox multivariate analysis, a high PC CRP was associated with an increased risk of mortality when compared with the low PC CRP; relative risk (RR) 2.74 (95% CI 1.9–4.0). A high PC CRP was also associated with an increased risk of TRM; RR 3.3 (95% CI 2.1–5.4). However, there was no association with relapse; RR 0.94 (95% CI 0.6–1.6), nor with Grade 2–4 acute graft-versus-host disease (aGVHD); RR 1.1 (95% CI 0.6–2.1). No differences between the three CRP categories with respect to causes of death were observed, suggesting that an elevated CRP increases the risk of TRM in an indiscriminate manner. The intermediate CRP group had an increased risk of mortality (RR 1.3 [95% CI 0.9–1.8]) and TRM (RR 1.3 [95% CI 0.8–2.0]) when compared with the low group but this was not statistically significant. However, in the sibling donor cohort, the relative risks of mortality were 3.2 (95% CI 1.6–6.3) and 5.9 (95% CI 2.8–12.3) for the intermediate and high groups, whilst for the unrelated donor cohort, the relative risks were 0.9 (95% CI 0.6–1.4) and 2.1 (95% CI 1.3–3.4) respectively. Thus the impact of PC CRP is more significant in recipients of sibling donor transplants. In order to investigate infection as a potential cause of an increased PC CRP, patient records were reviewed for evidence of bacteremia. There was no significant difference between the 3 CRP groups: 0.7%, 1.3% and 1.2% respectively. In this study, we have demonstrated that an elevated PC CRP is predictive of decreased survival secondary to increased TRM, even in patients with an intermediate level PC CRP that would conventionally be considered clinically insignificant. We postulate that an increased PC CRP may reflect an underlying predisposition that results in a reduced ability to tolerate the stress of a stem cell transplant. In patients who have a high PC CRP, it may be prudent to investigate the etiology of the elevated CRP and consider delay of transplantation until the CRP normalises.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».