D-index: A New Scoring System in Febrile Neutropenic Patients for Predicting Invasive Fungal Infections

Yılmaz, Gülden; Coşkun, Belgin; Elhan, Atilla Halil; Azap, Alpay; Akan, Hamdı

doi:10.4274/tjh.2014.0070

Cited by 8 publications

(13 citation statements)

References 22 publications

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“…We found a 3.8% increased risk of developing IFD by each additional day of neutropenia per 100 days follow up. Other studies have utilized the D-index, based on the area over the neutrophil curve which is defined by the duration and severity of neutropenia, as a predictor of risk factor for invasive mold infections in leukemia patients [ 22 , 23 , 24 ]. Our calculation differs in that it includes the cumulative duration of neutropenia over the first year, rather than depth and persistence of neutropenia during a single neutropenic episode prior to the diagnosis of IFD.…”

Section: Discussionmentioning

confidence: 99%

Invasive Fungal Disease in Patients with Newly Diagnosed Acute Myeloid Leukemia

Wasylyshyn

Linder

Kauffman

et al. 2021

JoF

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This single-center retrospective study of invasive fungal disease (IFD) enrolled 251 adult patients undergoing induction chemotherapy for newly diagnosed acute myeloid leukemia (AML) from 2014–2019. Patients had primary AML (n = 148, 59%); antecedent myelodysplastic syndrome (n = 76, 30%), or secondary AML (n = 27, 11%). Seventy-five patients (30%) received an allogeneic hematopoietic cell transplant within the first year after induction chemotherapy. Proven/probable IFD occurred in 17 patients (7%). Twelve of the 17 (71%) were mold infections, including aspergillosis (n = 6), fusariosis (n = 3), and mucomycosis (n = 3). Eight breakthrough IFD (B-IFD), seven of which were due to molds, occurred in patients taking antifungal prophylaxis. Patients with proven/probable IFD had a significantly greater number of cumulative neutropenic days than those without an IFD, HR = 1.038 (95% CI 1.018–1.059), p = 0.0001. By cause-specific proportional hazards regression, the risk for IFD increased by 3.8% for each day of neutropenia per 100 days of follow up. Relapsed/refractory AML significantly increased the risk for IFD, HR = 7.562 (2.585–22.123), p = 0.0002, and Kaplan-Meier analysis showed significantly higher mortality at 1 year in patients who developed a proven/probable IFD, p = 0.02. IFD remains an important problem among patients with AML despite the use of antifungal prophylaxis, and development of IFD is associated with increased mortality in these patients.

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Section: Discussionmentioning

confidence: 99%

Invasive Fungal Disease in Patients with Newly Diagnosed Acute Myeloid Leukemia

Wasylyshyn

Linder

Kauffman

et al. 2021

JoF

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“…The duration of neutropenia was significantly different between groups; the median time for the non-BSI group was 13 days (IQR, 11-17 days), whereas for the BSI group, it was 16 days (IQR, 12-20 days) (P = .002). Similarly, the median duration of profound neutropenia was significantly different between groups (non-BSI, 10 [IQR, [8][9][10][11][12][13] As shown in the ROC curves (Figure 4), as a marker, the performance of the D-index 0 was similar to that of the duration of profound neutropenia and slightly better than the duration of neutropenia.…”

Section: Development Of Bsi (Primary Outcome)mentioning

confidence: 73%

“…The authors recommended using the D‐index to assess the pretest probability of IMI and to complement positive results of serum galactomannan and β‐ d ‐glucan tests. Since then, the D‐index has been used, with mixed results, to predict invasive fungal infections (IFI) in adult or pediatric patients with AML, 10,24 in patients undergoing HSCT or reduced‐intensity HSCT, 13,14,25 in patients receiving consolidation chemotherapy for AML with high‐dose cytarabine, 9 and in patients receiving induction therapy for acute lymphoblastic leukemia and lymphoma 11 . Of these prior studies, the largest sample size was 68 patients 13 .…”

Section: Discussionmentioning

confidence: 99%

“…These investigators showed that the D‐index successfully predicted invasive mold infection (IMI) in patients with acute myeloid leukemia (AML). Subsequently, the D‐index has been evaluated as a marker for pulmonary infections, mucositis, and BSI in different cohorts of patients with hematologic malignancies 9‐14 . In this study, we evaluated the utility of the D‐index as a marker for development of BSI in patients who had undergone allogeneic HSCT.…”

Section: Introductionmentioning

confidence: 99%

“…Subsequently, the D-index has been evaluated as a marker for pulmonary infections, mucositis, and BSI in different cohorts of patients with hematologic malignancies. [9][10][11][12][13][14] In this study, we evaluated the utility of the D-index as a marker for development of BSI in patients who had undergone allogeneic HSCT.…”

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confidence: 99%

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D‐index as a marker of bloodstream infections in patients with allogeneic hematopoietic stem cell transplantation

Vijayvargiya

Abad

Garrigos

et al. 2021

Transplant Infectious Dis

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Background Neutropenia is a risk factor for development of infections; however, the direct effect of neutropenia on development of bloodstream infection (BSI) is not known. D‐index, which is area between the neutrophil time curve and a neutrophil count of 0.5 × 109/L, incorporates the combined effect of severity and duration of neutropenia. We aimed to evaluate whether D‐index can be used as a marker for BSI in patients with allogeneic stem cell transplantation. Method We conducted a retrospective cohort study of patients undergoing allogeneic stem cell transplantation between January 1, 2005, and September 30, 2015. The primary outcome measure was the development of BSI within 30 days of transplantation. Results A total of 714 patients were included in the study of whom 101 developed BSI. Patients with BSI had a significantly higher median D‐index value compared with patients who did not have BSI (4990 vs. 3570, P < .001). As a marker, the performance of the D‐index was similar to that of the duration of profound neutropenia (P = .18) and significantly better than the total duration of neutropenia (P = .001). Conclusion The D‐index performed better than the total duration of neutropenia as a marker for BSI in patients with allogeneic stem cell transplantation. There was no difference between D‐index and, a more easily calculable indicator, duration of profound neutropenia.

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c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

et al. 2022

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Acute myeloid leukemia (AML) often requires long-term intensive chemotherapy for its cure. During chemotherapy, the patient always experiences neutropenia with readings below 500 cells/μL; this is often accompanied by pyrexia with a temperature of more than 101°F. This combination of neutropenia and fever is called febrile neutropenia (FN). A tool to sum up the daily severity of a patient’s neutropenia, the “D-index,” has been validated in some specific clinical settings. In this study, we examined whether the D-index is a useful predictor of the onset of FN. We recruited consecutive patients treated with induction and consolidation chemotherapy for newly diagnosed AML. We gathered all the FN events and their clinical background data retrospectively. Patients’ background, such as pre-existing conditions and disease status before the treatment, were analyzed using multivariate methods. All FN events during chemotherapy were evaluated for infection focus and causative organism. A total cohort of 51 cases (25 women, 26 men; median age 51 years, range 18–74) was analyzed. They displayed 171 neutropenic events (115 FN and 56 afebrile episodes) during chemotherapy, and complete neutropenic events were used in this study. Sensitivity and specificity analysis showed that the most useful cutoff value to predict the onset of FN was a cumulative D-index at day 11 (c-D11-index) of 718. The cumulative incidence of FN during chemotherapy was significantly higher in the group with c-D11-index ≥710 (80%) than in the group with c-D11-index <710 (39%) (P < 0.0001). Through multivariate analysis, the presence of diabetes mellitus and the c-D11-index were extracted as contributing factors to the onset of FN (P = 0.0087 and 0.0002, respectively). In conclusion, we can predict that AML patients receiving chemotherapy will experience the complication of FN when the c-D-index at day 11 is >710, with an odds ratio of 2.1.

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D-index: A New Scoring System in Febrile Neutropenic Patients for Predicting Invasive Fungal Infections

Cited by 8 publications

References 22 publications

Invasive Fungal Disease in Patients with Newly Diagnosed Acute Myeloid Leukemia

Invasive Fungal Disease in Patients with Newly Diagnosed Acute Myeloid Leukemia

D‐index as a marker of bloodstream infections in patients with allogeneic hematopoietic stem cell transplantation

c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

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