Highlights
- •We analysed 19 risk factors for invasive mould disease (IMD) in 1944 adult haematology patients.
- •Seven risk factors at hospital admission differentiated patients who developed IMD with 85% accuracy.
- •The risk model also identified patients with high risk of IMD despite “low risk” malignancies.
- •Further validation and development of such models can support diagnostic /antifungal stewardship.
Abstract
Objective
Our objective was to develop a model that predicts a patient's risk of developing
invasive mould disease (IMD) within 60 days of admission for treatment of a haematological
malignancy.
Methods
We analysed 19 risk factors for IMD in a cohort of 1944 adult patients with haematological
malignancies over 4127 admissions at a haematology referral centre in Northern Italy
(2007-2016). We used a multivariable logistic regression to estimate the 60-day probability
of developing probable or proven IMD. The model was internally validated using a bootstrap
resampling procedure.
Results
The prevalence of IMD was 3.3% (90 probable cases, 43 proven cases). Seven risk factors
were retained in the final risk model: (1) uncontrolled malignancy, (2) high-risk
chemotherapy regimen, (3) high-dose corticosteroids, (4) severe lymphopenia, (5) CMV
reactivation or disease, (6) prolonged neutropenia, and (7) a history of previous
IMD within 90 days. The model displayed good calibration and discrimination in both
the derivation (aROC 0.85, 95% CI 0.84-0.86) and validation (aROC 0.83 95% CI 0.79-0.89)
populations.
Conclusions
Our model differentiated with 85% accuracy whether or not patients developed IMD within
60-days of admission. Individualized risk assessment, aided by validated prognostic
models, could assist IMD management and improve antifungal stewardship.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 08, 2019
Accepted:
April 4,
2019
Identification
Copyright
© 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
