Prognostic Value Of Charson Comorbidities Index In Patients With Acute Myeloid Leukemia

Objective:To analyze The clinical characteristics of The Charlson Comorbidity Index(CCI)in patients with adult Acute myeloid leukemia(AML),and explore the influence of CCI score on the prognosis of patients with AML.To provide some guidance for the decision of clinical treatment program.Methods:Using retrospective analysis and strictly following inclusion and exclusion criteria,109 patients with AML(non-acute promyelocytic leukemia)diagnosed for the first time in the First Affiliated Hospital of Gannan Medical University were enrolled in this study from June 2019 to October 2022.Personal Information,laboratory tests,imaging data,induction chemotherapy regimen,chromosome karyotype,gene,Bone marrow blasts and survival time of all patients were collected,and the specific complications of patients were recorded,and specific scores were calculated according to the CCI scoring table.Factors affecting Complete remission rate of AML patients after firstinduction chemotherapy were analyzed by Logistic univariate and multifactor regression,and the predictive value of CCI score and risk stratification for CR remission of first-induction chemotherapy patients was evaluated by ROC curve.Kaplan.Meier(K.M)survival curve was used to describe the distribution of survival status.Results:1.A total of 109 adult patients diagnosed with AML in our hospital from June 2019 to October 2022 were collected according to inclusion and exclusion criteria,and the follow-up was ended on February 28,2023.Patients’ scores were calculated according to the CCI scoring table,There were 65 patients with CCI=0,31 patients with CCI=1,and 13 patients with CCI≥2,Patients were divided into 3 groups according to CCI score: CCI0 group,CCI1 group,and CCI≥2 group.Results There were no significant differences in age,sex,hemoglobin,white blood cells,platelets,albumin,bilirubin and creatinine among the 3 groups(P > 0.05).Remission of first induction chemotherapy was statistically significant in the 3 groups(P=0.026).2.Univariate logistic regression analysis was conducted on the factors that might affect the remission of patients with the first induction chemotherapy.The results showed that induction chemotherapy regimen(P=0.017),complicated liver disease(P=0.019),and CCI score(P=0.035)were correlated with CR of patients with the first induction chemotherapy.They are factors influencing CR in patients with first induction chemotherapy.(Induction chemotherapy regimen,combined liver disease,and CCI score were all defined in the study methodology).3.Multivariate Logistic regression analysis of risk factors affecting remission of first-induction chemotherapy in AML patients showed no statistical significance in liver disease and risk stratification(P > 0.05).There were significant differences in induction chemotherapy regimen(P=0.002)and CCI score(P=0.042),indicating that induction chemotherapy regimen and CCI score were independent predictors of remission of first induction chemotherapy in AML patients.4.ROC curve was used to analyze the predictive value of CCI score for CR in AML patients undergoing first induction chemotherapy.The results showed that the area under CCI score curve was 0.626(95%CI: 0.520-0.731,P=0.024),the sensitivity was 0.702,and the specificity was 0.519.The area under the curve of risk stratification(high risk,non-high risk)was 0.567(95%CI 0.459-0.676,P=0.225),sensitivity was0.596,specificity was 0.538.The area under the curve of CCI score combined with risk stratification was 0.642(95%CI 0.538-0.747,P=0.010).The sensitivity was 0.842 and the specificity was 0.404.The results showed that CCI score had a certain value in predicting the remission rate of first induction chemotherapy.5.K.M survival curve was drawn to describe the survival status of AML patients.It was found that among patients with 0 CCI score,the median OS was 694 days(95%CI 529.206-858.794),and among patients with 1 CCI score,The median OS was395 days(95%CI 263.071 to 526.929),and among patients with CCI score ≥2,the median OS was 158 days(95%CI 82.843-233.157),P=0.002,the difference was statistically significant.The CCI score was compared between the two groups,and there was statistical significance in OS between the two groups(P=0.001).There was statistical significance in OS between groups with CCI score of 1 and ≥2(P=0.018).The results showed that the higher the CCI score,the shorter the survival time.Conclusion:1.The remission rate of first induction chemotherapy is higher in AML patients receiving strong induction chemotherapy.Therefore,in the selection of induction chemotherapy regimen,strong induction chemotherapy regimen should be adopted if patients can tolerate.2.CCI score has a certain predictive value for the overall survival time of AML patients.The higher the CCI score,the shorter the survival time of patients.