严重出血是新诊断的急性早幼粒细胞白血病(APL)患者早期死亡的主要原因。然而,在APL中没有出血危险分层的方法.本研究旨在确定与APL相关的严重出血事件的优化预测因子。回顾性分析2015年1月至2022年4月109例新诊断的APL患者。对基于计算机的患者病历进行了系统审查,以获得临床日期,包括基线特征,血常规检查结果,凝血和纤溶指标,出血事件。在109名患者中,89例患者归入无严重出血组,而20人严重出血。与无严重出血的患者相比,严重出血患者的循环白血病细胞百分比明显较高,弥散性血管内凝血(DIC)评分,D-二聚体(D-D)水平,和纤维蛋白降解产物(FDP)水平。他们还具有较低的纤维蛋白原(FIB)水平和更长的凝血酶原时间。多因素分析显示循环白血病细胞百分比(OR=1.040,CI=1.008~1.072,P=0.012),FIB水平(OR=0.101,CI=0.011-0.896,P=0.040),FDP水平(OR=1.012,CI=1.000~1.024,P=0.047)是严重出血的独立危险因素。FDP/FIB,D-D/FIB,单因素分析中的7个有意义的指标包括在受试者工作特征(ROC)曲线分析中。结果表明,FDP/FIB是预测新诊断APL相关严重出血的最佳指标。FDP/FIB的ROC曲线下面积为0.915,最佳截断值为61.77,敏感性为100%,特异性为74.2%。统计学分析显示,当FDP/FIB>61.77时,APL患者的严重出血发生率更高,DIC评分更高。FDP/FIB在预测原发性早幼粒细胞白血病出血程度方面具有明显优势;FDP/FIB值越大,出血越严重。当FDP/FIB>61.77时,严重出血的风险最高。
Severe bleeding is the leading cause of early death in patients with newly diagnosed acute promyelocytic leukemia (APL). However, there are no means for hemorrhagic risk stratification in APL. This study aimed to identify optimized predictors of severe bleeding events related to APL. A total of 109 consecutive patients with newly diagnosed APL from January 2015 to April 2022 were retrospectively investigated. A systematic review of computer-based patient medical records was conducted to obtain clinical date, including baseline characteristics, routine blood examination findings, coagulation and fibrinolysis indexes, and bleeding events. Among the 109 patients, 89 were classified into the no-severe bleeding group, while 20 had severe bleeding. Compared with the patients with no severe bleeding, the patients with severe bleeding had significantly higher circulating leukemic cell percentages, disseminated intravascular coagulation (DIC) scores, D-dimer (D-D) levels, and fibrin degradation product (FDP) levels. They also had lower fibrinogen (FIB) levels and a longer prothrombin time. Multivariate analysis revealed that the circulating leukemic cell percentage (OR = 1.040, CI = 1.008-1.072, P = 0.012), FIB level (OR = 0.101, CI = 0.011-0.896, P = 0.040), and FDP level (OR = 1.012, CI = 1.000-1.024, P = 0.047) were independent risk factors for severe bleeding. FDP/FIB, D-D/FIB, and seven meaningful indicators in the single-factor analysis were included in the receiver operating characteristic (ROC) curve analysis. The results showed that FDP/FIB was the best indicator for predicting severe bleeding related to newly diagnosed APL. The area under the ROC curve of FDP/FIB was 0.915, and the best cutoff value was 61.77, with 100% sensitivity and 74.2% specificity. Statistical analysis showed a higher incidence of severe bleeding and higher DIC scores when FDP/FIB was >61.77 in APL patients. FDP/FIB has obvious advantages in predicting the degree of bleeding associated with primary promyelocytic leukemia; the greater the FDP/FIB value, the more severe the bleeding. The risk of severe bleeding was the highest when FDP/FIB > 61.77.