Analysis Of Early Death Factors In 774 Patients With Acute Myeloid Leukemia

ObjectiveThe objective of this research is to clarify the main causes of early death(ED,died within 30 days)in adult patients with acute myeloid leukemia(AML)and the relevant risk factors,so as to intervene the risk factors related to ED in AML patients early,reduce the rate of ED and further improve the survival of patients.MethodFirstly,a total of 918 cases of adult AML patients that were initially treated in the First Affiliated Hospital of Nanchang University from January 2014 to December 2019 were collected,in which 617 NAPL patients and APL 157 patients were taken as research objects to conduct a retrospective case-control study finally.And then,NAPL and APL patients were divided into ED group and non-ED group,while continuous variables and categorical variables were used to compare the differences between the two groups with independent sample t test and chi-square test,respectively;Secondly,the logistic single factor regression was used for the index of t-test or chi-square test with statistical differences and the risk factors related to ED in AML patients in previous literature reports.And then,the index P<0.1 in single factor regression was included in the logistic multi-factor regression.All data were processed with IBM SPSS Statistics22 software.Results1.In this study,774 patients with AML were collected:including 617 NAPL patients and 157 APL patients.The median age of NAPL patients was 50 years old(from 18 to 85 years old),with 59 ED patients(9.5%).The main cause of ED in patients with NAPL age<60 years old was intracranial hemorrhage;and the main cause of ED in patients with NAPL age?60 years old was primary disease progression.The median age of patients with APL was 43 years old(from 18 to 79years old)and 14 patients with ED(8.9%)were mainly caused by intracranial hemorrhage.2.The results of logistic single factor regression are as follows:(1)For age<60years old NAPL patients in ED group and non-ED group:WBC?100×10~9/L,PLT?30×10~9/L and PT?15s,with statistical difference;For age?60 years old NAPL patients in ED group and non-ED group:DD?10mg/L,LDH?1500U/L with statistical difference;(2)For APL patients(?50 years old)in ED group and non-ED group:WBC?10×10~9/L and ECOG PS score?2,with statistical difference(all P<0.05).3.The results of logistic multi-factor regression are as follows:(1)WBC?100×10~9/L,PLT<30×10~9/L and PT?15s are the risk factors of ED in age<60 years old NAPL patients,and DD?10mg/L,LDH?1500U/L are the risk factor of ED in age?60 years old NAPL patients;(2)Age?50 years,WBC?10×10~9/L and ECOG PS score?2 are the risk factors of ED in APL patients.Conclusions:1.(1)Intracranial hemorrhage is the main cause of ED in NAPL patients(age<60 years old),while the patients with WBC?100×10~9/L,PLT<30×10~9/L and PT?15s have a higher risk of ED;(2)During the treatment,ED of such patients may be reduced by closely monitoring the coagulation function,actively correcting the abnormal coagulation function and strengthening the supportive treatment of PLT;(3)The patients with DD?10 mg/L,LDH?1500U/L among NAPL patients(age?60years old)has a higher risk of ED.2.(1)Through the treatment with all-trans retinoic acid(ATRA),intracranial hemorrhage is still the main cause of ED in APL patients;(2)APL patients with age?50 years,WBC?10×10~9/L and ECOG PS score?2 have a higher risk of ED.