Risk stratification system for skin and soft tissue infections after allogeneic hematopoietic stem cell transplantation: PAH risk score

Abstract

Skin and soft tissue infections (SSTIs) refer to infections involving the skin, subcutaneous tissue, fascia, and muscle. In transplant populations with hematological malignancies, an immunocompromised status and the routine use of immunosuppressants increase the risk of SSTIs greatly. However, to date, the profiles and clinical outcomes of SSTIs in hematopoietic stem cell transplantation (HSCT) patients remain unclear. This study included 228 patients (3.67%) who developed SSTIs within 180 days after allogeneic HSCT from January 2004 to December 2019 in Peking University People’s Hospital. The overall annual survival rate was 71.5%. We compared the differences between survivors and non-survivors a year after transplant and found that primary platelet graft failure (PPGF), comorbidities of acute kidney injury (AKI), and hospital-acquired pneumonia (HAP) were independent risk factors for death in the study population. A PPGF–AKI–HAP risk stratification system was established with a mortality risk score of 1×PPGF+1×AKI+1×HAP. The areas under the curves of internal and external validation were 0.833 (95% CI 0.760–0.906) and 0.826 (95% CI 0.715–0.937), respectively. The calibration plot revealed the high consistency of the estimated risks, and decision curve analysis showed considerable net benefits for patients.

Keywords

skin and soft tissue infections / hematopoietic stem cell transplantation / risk stratification system / mortality

References

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Acknowledgements

This work was supported by National Key Research and Development Program of China (No. 2017YFA0105503), National Natural Science Foundation of China (Nos. 81970113 and 81800116), Key Program of National Natural Science Foundation of China (No. 81730004), and Beijing Natural Science Foundation (No. H2018206423).

Compliance with ethics guidelines

Shan Chong, Yun He, Yejun Wu, Peng Zhao, Xiaolu Zhu, Fengrong Wang, Yuanyuan Zhang, Xiaodong Mo, Wei Han, Jingzhi Wang, Yu Wang, Huan Chen, Yuhong Chen, Xiangyu Zhao, Yingjun Chang, Lanping Xu, Kaiyan Liu, Xiaojun Huang, and Xiaohui Zhangy have no conflicts of interest to declare. This study was conducted in accordance with Declaration of Helsinki strictly and authorized by Peking University People’s Hospital ethics committee.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-021-0910-1 and is accessible for authorized users.

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