多发性骨髓瘤(MM)患者由于潜在的疾病和治疗相关的免疫抑制而发生败血症的风险增加。然而,关于脓毒症发病率的数据,致病性病原体,对新诊断MM(NDMM)结局的影响有限。我们对2022年至2023年在意大利三级护理中心发生脓毒症的92名NDMM患者进行了回顾性观察研究。患者特征,脓毒症标准[快速序贯器官衰竭评估,全身炎症反应综合征(SIRS)],微生物学结果,并分析与无进展生存期(PFS)的相关性。在这个由92名危重病人组成的队列中,通过微生物培养鉴定了74例病原生物。然而,在其余18名文化阴性患者中,图9显示SIRS评分为2,另外9显示SIRS评分为4,提示尽管培养为阴性,但临床表现与脓毒症一致。常见的合并症包括肾衰竭(60%),贫血(71%),和骨骼疾病(83%)。革兰氏阴性(28%)和革兰氏阳性(23%)细菌是常见的致病生物,以及真菌(20%)。PFS的Cox单变量分析显示,白蛋白≥3.5与<3.5患者的HR具有统计学意义(HR=5.04,p<0.001),Karnofsky绩效状态≥80vs<80(HR=2.01,p=0.002),通过国际分期系统(HR=4.76和HR=12.52,均p<0.001)和修订的国际分期系统(R-ISSIII与R-ISSI,HR=7.38,p<0.001)。脓毒症在NDMM中很常见,并与不良预后相关。结合脓毒症严重程度的风险分层,合并症,疾病阶段可能有助于指导预防策略和优化MM管理。
Patients with multiple myeloma (MM) have an increased risk of sepsis due to underlying disease- and treatment-related immunosuppression. However, data on sepsis incidence, causative pathogens, and impact on outcomes in newly diagnosed MM (NDMM) are limited. We conducted a retrospective observational study of 92 NDMM patients who developed sepsis between 2022 and 2023 at a tertiary care center in Italy. Patient characteristics, sepsis criteria [Quick Sequential Organ Failure Assessment, Systemic Inflammatory Response Syndrome (SIRS)], microbiology results, and associations with progression-free survival (PFS) were analyzed. In this cohort of 92 critically-ill patients, pathogenic organisms were identified via microbiological culture in 74 cases. However, among the remaining 18 culture-negative patients, 9 exhibited a SIRS score of 2 and another 9 had a SIRS score of 4, suggestive of a clinical presentation consistent with sepsis despite negative cultures. Common comorbidities included renal failure (60%), anemia (71%), and bone disease (83%). Gram-negative (28%) and Gram-positive (23%) bacteria were frequent causative organisms, along with fungi (20%). Cox Univariate analyses for PFS showed statically significant HR in patients with albumin ≥ 3.5 vs < 3.5 (HR = 5.04, p < 0.001), Karnofsky performance status ≥ 80 vs < 80 (HR = 2.01, p = 0.002), and early-stage vs late-stage disease by International Staging System (HR = 4.76 and HR = 12.52, both p < 0.001) and Revised International Staging System (R-ISS III vs R-ISS I, HR = 7.38, p < 0.001). Sepsis is common in NDMM and associated with poor outcomes. Risk stratification incorporating sepsis severity, comorbidities, and disease stage may help guide preventive strategies and optimize MM management.