Analysis Of Influential Factors And Prognosis Of Patients With Acute Promyelocytic Leukemia Complicated With Disseminated Intravascular Coagulation

Objective:Disseminated intravascular coagulation(DIC)is one of the leading causes of early death in patients with acute promyelocytic leukemia(APL).To explore the influencing factors and prognosis of APL combined with DIC,improve the DIC of APL patients,minimize the mortality rate of patients and provide reliable reference for early clinical diagnosis.Methods:The clinical data of 199 newly diagnosed APL patients were retrospectively analyzed,and 132 cases were collected.According to clinical manifestations,main laboratory indicators,especially important coagulation indicators,the patients were divided into DIC group and non-DIC group.The differences in basic information,clinical manifestations,laboratory indicators,behavioral life and prognosis indexes were compared between the two groups.Univariate and multivariate regression analysis was used to explore the influential factors of APL complicated with DIC.Follow-up was performed through review of patient medical records and telephone inquiries for prognostic analysis.SPSS 26.0statistical software was used to analyze and process the data.Receiver operating(ROC)curves were plotted using R 4.1.0 software.Results:1、The average age of newly diagnosed APL patients was 41.94±16.61 years old,and they were divided into DIC group(106 cases,53.27%)and non-DIC group(93 cases,46.73%)according to clinical and laboratory indicators.2、Analysis of clinical data of newly diagnosed APL patients: Univariate analysis results showed that there were statistically significant differences in white blood cell count(WBC)at initial diagnosis,absolute neutrophil count(ANC),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),fibrinogen degradation products(FDP),D-dimer,lactate dehydrogenase(LDH),risk stratification and bone marrow promyelocytic percentage between the DIC group and the non-DIC group at initial diagnosis(All P <0.05).Multivariate analysis results showed that the levels of FIB,FDP and LDH at initial diagnosis were independent influencing factors of APL combined with DIC(all P < 0.05),the ORs were 0.460(0.296,0.714),1.008(1.001,1.016)and 1.005(1.003,1.007).ROC curve was used to select the optimal threshold of each index of APL patients with DIC.The optimal threshold for FIB was 1.725g/L,the optimal threshold for FDP was 80.45μg/m L,and the optimal threshold for LDH was 411.5U/L.Moreover,the ROC curve of the multivariate Logistic model showed that the area under the curve was 0.846,and the optimal threshold was 42.07%,and its combined prediction value was higher than that of a single index.3、Analysis of Behavioral life of patients with first-time APL: Univariate analysis showed that the frequency of drinking alcohol in newly diagnosed APL patients may be related to DIC.Multivariate analysis results showed that FIB and LDH were the influencing factors of DIC in APL drinking patients(all P < 0.05),OR was 0.119(0.017,0.815)and 1.013(1.001,1.026).4、Prognosis analysis: The early case fatality rate of APL patients were 10.55%,15.09% in DIC group and 5.38% in non-DIC group.The overall survival rate was 86.05%,79.35% in the DIC group and 93.75% in the non-DIC group.There was statistical significance in the early case fatality rate and overall survival rate between the two groups(P < 0.05),but no statistical significance in the difference between adverse reactions and duration of discontinuation(P > 0.05).Conclusion:1、There were differences in many indexes between the DIC group and the non-DIC group in newly diagnosed APL patients,especially FIB,FDP and LDH were independent influential factors of APL patients combined with DIC.When the FIB value is less than1.725 g/L,the FDP value is higher than 80.45 μg/m L,and the LDH value is higher than411.5 U/L,the risk of possible DIC in patients with APL is higher.2、The frequency of drinking alcohol in newly diagnosed APL patients may be related to DIC,and FIB and LDH are closely related to the occurrence of DIC in patients with APL drinking.3、The early case fatality rate of newly diagnosed APL patients in DIC group was higher than that in non-DIC group,and the overall survival rate was lower than that in non-DIC group.4、For newly diagnosed APL patients,DIC should be detected as early as possible,timely diagnosis and active symptomatic support treatment can reduce early mortality.