Peking University People’s Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
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.
Viral infections characterized by skin and mucous membrane lesions
B00.XXX–B09.XXX
20 (8.8)
Dermatophytosis
B35.XXX
2 (0.88)
Candidiasis of skin and nail
B37.201
2 (0.88)
Anal abscess
K61.002
13 (5.7)
Perianal infection
K62.805
22 (9.6)
Cutaneous abscess, furuncle, and carbuncle
L02.XXX
4 (1.8)
Cellulitis
L03.XXX
13 (5.7)
Other local infections of skin and subcutaneous tissue
L08.XXX
110 (48.2)
Decubitus ulcer
L89.XXX
3 (1.3)
Gangrene
R02.XXX
1 (0.4)
Infection and inflammatory reaction due to vascular devices
T82.703
28 (12.3)
Infection following a procedure, not elsewhere classified
T81.XXX
2 (0.88)
Tab.1
Characteristics
Survivors
Non-survivors
P
No. of patients
167
61
Gender, n (%)
0.980
Male
118 (70.7%)
43 (70.5%)
Female
49 (29.3%)
18 (29.5%)
Age (diagnosed with pneumonia), year, mean ± SD
32.68 ± 13.733
38.28 ± 12.731
0.006*
Underlying diseases, n (%)
0.467
AML
53 (31.7%)
16 (26.2%)
ALL
71 (42.5%)
27 (44.3%)
CML
9 (5.4%)
1 (1.6%)
MDS
27 (16.2%)
11 (18.0%)
NHL
2 (1.2%)
2 (3.3%)
Others
5 (3.0%)
4 (6.6%)
HCT-CI, n (%)
0.316
0
130 (77.8%)
46 (75.4%)
1
29 (17.4%)
8 (13.1%)
2
6 (3.6%)
6 (9.8%)
3
2 (1.2%)
1 (1.6%)
Median time from diagnosis to HSCT, month (range)
6 (2–144)
6 (2–240)
0.863
Disease status, n (%)
0.032*
CR
137 (82.0%)
42 (68.9%)
Advanced disease
30 (18.0%)
19 (31.1%)
Donor, n (%)
0.232
MRD
4 (2.4%)
2 (3.3%)
MUD
43 (25.7%)
15 (24.6%)
HID
119 (71.3%)
41 (67.2%)
CB
1 (0.6%)
3 (4.9%)
Gender relationship, n (%)
0.874
M−M
78 (46.7%)
33 (54.1%)
M−F
38 (22.8%)
11 (18.0%)
F−M
37 (22.2%)
12 (19.7%)
F−F
14 (8.4%)
5 (8.2%)
ABO compatibility, n (%)
0.467
Match
102 (61.1%)
34 (55.7%)
Mismatch
66 (38.9%)
27 (44.3%)
HLA compatibility, n (%)
0.433
Match
47 (28.1%)
17 (23.0%)
Haplo-identical
120 (71.9%)
44 (77.0%)
Graft source
0.149
BM + PB
158 (94.6%)
56 (91.8%)
BM
2 (1.2%)
0
PB
6 (3.6%)
2 (3.3%)
CB
1 (0.6%)
3 (4.9%)
MNCs ( × 108/kg, mean ± SD)
8.21 ± 1.67
8.04 ± 1.72
0.481
CD34+( × 106/kg, mean ± SD)
2.67 ± 1.37
2.79 ± 1.46
0.558
Median WBC engraftment time, day (range)a
14 (10–28)
14 (9–23)
0.361
Median PLT engraftment time, day (range)b
16 (6–170)
15 (10–153)
0.684
Antecedent aGVHD, n (%)
0.040*
None
151 (90.4%)
47 (77.0%)
I–II
11 (6.6%)
9 (14.8%)
III–IV
5 (3.0%)
5 (8.2%)
Antecedent cGVHD, n (%)
3 (1.8%)
3 (4.9%)
0.403
Antecedent CMV viremia
27 (16.2%)
14 (23%)
0.238
Antecedent EBV viremia
4 (2.4%)
2 (3.3%)
0.718
Tab.2
Locations of SSTIs
No. of patients (%)
Maxillofacial infection
47 (20.6%)
Infection due to vascular devices
41 (18.0%)
Anal infection
40 (17.5%)
Lower limbs infection
29 (12.7%)
Upper limbs infection
11 (4.8%)
Back infection
11 (4.8%)
External genital infection
9 (3.9%)
Front trunk infection
9 (3.9%)
Hip infection
8 (3.5%)
Hands infection
8 (3.5%)
Feet infection
8 (3.5%)
Neck infection
3 (1.3%)
Perineum infection
2 (0.9%)
Multiple systemic infections
2 (0.9%)
Tab.3
Features
Univariate
Multivariate
OR
95% CI
P
OR
95% CI
P
Age > 60 years
0.897
0.091–8.862
0.926
Disease status
1.852
0.832–4.118
0.131
History of diabetes mellitus, n (%)
3.565
1.125–11.298
0.031*
4.250
0.914–19.766
0.065
ABO matched
1.189
0.588–2.403
0.630
HLA matched
1.146
0.489–2.686
0.754
Primary platelet graft failure
24.348
7.606–77.941
< 0.001*
11.726
3.202–42.941
< 0.001*
CMV viremia
1.244
0.497–3.116
0.641
EBV viremia
2.227
0.582–8.911
0.237
aGVHD
1.960
0.877–4.382
0.101
1.216
0.474–3.120
0.685
cGVHD
5.610
0.495–63.516
0.164
SSTIs at multiple locations
0.940
0.317–2.788
0.911
Complicated SSTIs
2.135
0.457–9.965
0.335
Hospital-acquired pneumonia
11.667
5.140–26.479
< 0.001*
5.765
2.223–14.952
< 0.001*
Hepatic failure
19.594
4.130–92.947
< 0.001*
6.116
0.858–43.594
0.071
Acute kidney injury
12.948
3.405–49.230
< 0.001*
9.948
2.040–48.512
0.004*
Tab.4
Variables
Multivariable analysis
Point
OR (95% CI)
P
Coefficients
Primary platelet graft failure
9.849 (3.293–29.459)
< 0.001
2.462
1
Acute kidney injury
10.618 (3.093–36.455)
0.004
2.397
1
Hospital-acquired pneumonia
6.654 (3.015–14.682)
< 0.001
1.752
1
Tab.5
Derivation cohort (n = 159)
Validation cohort (n = 69)
Low
Intermediate
High
Low
Intermediate
High
Risk score
0
1
2–3
0
1
2–3
Survivor
97
17
3
43
7
1
Non-survivor
9
15
19
4
9
5
Mortality
8.5%
46.9%
86.4%
8.5%
56.3%
83.3%
Tab.6
Fig.2
Fig.3
Fig.4
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