Progression of the Radiologic Severity Index is associated with increased mortality and healthcare resource utilisation in acute leukaemia patients with pneumonia

Abstract

BackgroundPneumonia is a major cause of mortality and morbidity, but the development of new antimicrobials is lacking. Radiological assessment of pneumonia severity may serve as an effective intermediate endpoint to reduce barriers to successful completion of antimicrobial trials. We sought to determine whether the Radiologic Severity Index (RSI) correlated with mortality and healthcare resource utilisation in patients with acute leukaemia undergoing induction chemotherapy.MethodsWe measured RSI (range 0–72) on all chest radiographs performed within 33 days of induction chemotherapy in 165 haematological malignancy patients with pneumonia. Peak RSI was defined as the highest RSI score within 33 days of induction. We used extended Cox proportional hazards models to measure the association of time-varying RSI with all-cause mortality within the first 33 days after induction chemotherapy, and logistic regression or generalised models to measure the association of RSI with total daily cost and healthcare resource utilisation.ResultsAfter adjustment for clinical variables, each one-point increase in RSI was associated with a 7% increase in all-cause 33-day mortality (HR 1.07, 95% CI 1.05 to 1.09, p<0.0001). Peak RSI values of 37.5 or higher were associated with 86% higher daily direct costs (p<0.0001), more days in intensive care unit (9.9 vs 4.8 days, p=0.001) and higher odds for mechanical ventilation (OR 12.1, p<0.0001).ConclusionsGreater radiological severity as measured by RSI was associated with increased mortality and morbidity in acute leukaemia patients with pneumonia. RSI is a promising intermediate marker of pneumonia severity and is well suited for use in antimicrobial trials.

Retrospective computed tomography assessment of chemotherapy-related pneumonia with severity screening in pediatric acute lymphoblastic leukemia by radiological imaging

“…Adult ALL exhibited a lower incidence (7.1 % [2.3–11.8 %]) of treatment-related pneumonia than adult acute myelogenous leukemia (AML, 21.6 %) and myelodysplastic syndrome (MDS, 29.4 %) [ 24 ]. Nevertheless, Sheshadri et al found that adult ALL with treatment-related pneumonia had higher mortality (10/12) than AML (86/177) and MDS (3/10) [ 20 ], all of which being significantly higher than the mortality (1/51, 2 %) in our study subjects. As a result, although chemotherapy-related pneumonia was the most important determinant of early mortality in adult leukemia [ 24 ], pneumonia in ALL children showed a lower rate of severe outcome (22 %) and mortality (2 %), based on the findings of the present study.…”

“…With reference to the Fleischner Society Thoracic Imaging Glossary [ 21 ], the images of ALL children with pneumonia symptoms were evaluated for the presence of the following findings: ground-glass opacity (GGO—a slight increase in attenuation without concealing underlying vessels and airway walls), consolidation (dense opacification with obscured broncho vascular margins), nodules (small rounded opacities), interstitial thickening, airway signs (stagnation, airway dilatation, or tree-bud sign), and the extrapulmonary lesions (pleural effusion or thoracic lymphadenopathy). The RSI score was calculated by multiplying the opacity (GGO or consolidation) and the involved percentage of six zones (i.e., bilateral upper, middle, or lower zones) [ 20 ]. A GGO was worth one point, whereas a dense cluster of nodules was worth two points.…”

“…In adult patients with acute leukemia, the severity score (radiologic severity index, RSI) was also used to assess treatment-related pulmonary infection [ 20 ]. The study found that each one-point increase in RSI was associated with a 7 % increase in mortality within 33 days.…”

“…The study found that each one-point increase in RSI was associated with a 7 % increase in mortality within 33 days. The highest (peak) RSI during pneumonia was associated with increased treatment costs, more time spent in the intensive care unit, and a greater possibility of requiring mechanical ventilation [ 20 ]. The goal of this study was to assess the RSI of chemotherapy-related pneumonia in ALL children and provide novel evidence for future studies and clinical practice.…”

Pneumonitis after immune checkpoint inhibitor therapies in patients with acute myeloid leukemia: A retrospective cohort study

“…The high rate of mortality among patients who developed pneumonitis is striking, and developing pneumonitis increased the hazard for death by nearly 3-fold. The impact of pneumonitis on mortality was similar to pneumonia 34 and cancer progression, both of which are well known to increase mortality. Higher baseline platelet counts and WBC counts were associated with better survival, perhaps indicating less aggressive disease, whereas more extensive treatment before ICI initiation predicted mortality.…”