Pb2576: news, news2 and qsofa accuracy to predict sepsis-related mortality in acute myeloid leukemia: a retrospective single-centre analysis

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Acute myeloid leukemia (AML) treated with intensive chemotherapy imposes a high risk of severe infection. The development of assessment tools for prompt identification of cases at risk of developing critical illness is vital to avoid a delayed admission to the intensive care unit (ICU), which can be associated with lower survival. qSOFA score and the National Early Warning Score (NEWS) have been proposed as mortality predictor tools to identify patients with AML and febrile neutropenia with major risk of clinical deterioration. Aims: To evaluate the accuracy of NEWS, NEWS2 and qSOFA in predicting sepsis-related mortality in AML and febrile neutropenia in the setting of intensive chemotherapy. Methods: Retrospective single-centre evaluation of patients with ≥ 18 years of age during intensive chemotherapy for AML between Jan/2012 and Jun/2022. The diagnosis of acute promyelocytic leukemia or previous hematopoietic stem cell transplantation were excluded. The scores were calculated at the day the patients started to show symptoms or signs suggestive of worsening of their clinical status. For the description of continuous variables, we used the median and the interquartile interval. The accuracy was assessed using the area under the receiver operating characteristic curve (AUROC). Results: We included a total of 365 febrile neutropenias in 126 patients: 63% (229/365) females, median age at admission of 53 years [43-63] and median Charlson comorbidity index 1 [0-2]. With regards to treatment phase, 50.1% (183/365) were admitted for induction and 49.9% (182/365) for consolidation. Sepsis-related mortality was 5% and ICU admission rate was 8%. The etiological agent was identified in 40% (145/365) of episodes: 30% (44/145) had gram-positive bacteria, 66% (95/145) gram-negative and 4% (6/145) a positive Aspergillus antigen. The median NEWS and NEWS2 scores were 3 [2-5] and qSOFA was 0 [0-1]. All scores showed excellent accuracy in predicting sepsis related mortality with AUROC values of 0.812 (95% CI [0.693-0.931], p<0.001), 0.858 (95% CI [0.747-0.970], p<0.001) and 0.848 (95% CI [0.736-0.959], p<0.001) for qSOFA, NEWS and NEWS2, respectively, as is shown in figure 1. Summary/Conclusion: In this study, qSOFA, NEWS and NEWS2 have shown excellent accuracy in predicting sepsis-related mortality in AML treated with intensive chemotherapy. These findings help to corroborate the utility of the evaluated scores as tracking systems in clinical practice for prompt identification of AML patients at risk of deterioration during febrile neutropenia.Figure 1: ROC curves of the accuracy of the scores qSOFA, NEWS and NEWS2 in predicting sepsis-related mortality. Keywords: Febrile neutropenia, Acute myeloid leukemia