Risk factors for secondary infection after chemotherapy in acute myeloid leukemia and construction of a risk prediction model
Deng Yuting
Gong Yuemin
Zhao Xiaoqian
Li Meng
Liu Yan
Meng Yixin
Shen Ying
Xia Yi
Abstract：Objective To investigate the risk factors for secondary infection after chemotherapy in patients with acute myeloid leukemia(AML)and to construct a risk prediction model.Methods This study included 204 AML patients treated at the First Affiliated Hospital with Nanjing Medical University from April 2022 to March 2024.Patients were assigned to an in-fection group(n=115)and a non-infection group(n=89)according to whether they developed secondary infection after chemotherapy.Multivariable forward logistic regression was used to identify factors associated with post-chemotherapy sec-ondary infection in AML patients,and a nomogram was constructed based on these factors.The predictive value of the no-mogram for secondary infection was assessed by receiver operating characteristic(ROC)curve analysis.Results The inci-dence of secondary infection after chemotherapy among the 204 AML patients was 56.37％(115/204),with 134 pathogens isolated in total:Gram-negative bacteria accounted for 52.99％,Gram-positive bacteria 35.82％,and fungi 11.19％.Multi-variable analysis indicated that age ≥ 60 years(OR=2.018;95％CI:1.404-2.900),chemotherapy intensity(high inten-sity)(OR=2.380;95％CI:1.589-3.564),length of hospital stay ≥4 weeks(OR=1.866;95％CI:1.322-2.635),receipt of glucocorticoid therapy(OR=2.166;95％CI:1.496-3.318),white blood cell count≥0.5 × 109/L(OR=0.331;95％CI:0.212-0.515),and elevated procalcitonin level(OR=2.654;95％CI:1.745-4.037)were factors asso-ciated with secondary infection after chemotherapy in AML patients(P＜0.05).The nomogram constructed to predict post-chemotherapy secondary infection in AML patients yielded a concordance index(C-index)of 0.873(95％CI:0.821-0.925).The area under the ROC curve(AUC)of the nomogram for predicting secondary infection was 0.862(95％CI:0.810-0.914),with a specificity of 68.24％and sensitivity of 92.16％.Conclusion Secondary infections after chemother-apy in AML patients are dominated by Gram-negative bacteria.The nomogram based on the identified risk factors has good predictive value for post-chemotherapy secondary infection in AML patients.
Keywords：Acute myeloid leukemiaChemotherapyInfectionRisk factorsNomogramPrediction model
Publication Date：2025-06-20
Online Publishing Date：2025-10-13(First online date of this platform, not the publication date of the document)
Pages：8( 91-98 )