Establishment Of Nutritional Index Model And Determination Of Cutoff Point In Hematopoietic Stem Cell Transplantation Patients

Objective 1.To analyze the influencing factors of hematopoietic reconstitution in patients with hematopoietic stem cell transplantation(HSCT);2.To explore the relationship between nutritional status and hematopoietic reconstitution before hematopoietic stem cell transplantation;3.Construct the nutritional index(NI)model of hematopoietic stem cell transplantation patients,and determine its cutoff point,so as to provide a screening toolfor patients who may have hematopoietic reconstruction failure or adverse risk.Method 1.In the retrospective study,340 cases of hematopoietic stem cell transplantation from January 2015 to December 2019 in Zhejiang provincial Hospital of traditional Chinese medicine transplantation center were selected for retrospective analysis.General demographic data,clinical data,nutritional indicators before pretreatment and hematopoietic reconstruction after hematopoietic stem cell transplantation were collected;2.Group t-test,chi square test and Fisher exact probability method were used to analyze the influencing factors of hematopoietic reconstitution;3.Select the nutrition index related to hematopoietic reconstitution,and construct the nutrition index model by principal component analysis;4.The influencing factors of hematopoietic reconstitution were analyzed by non conditional logistic regression analysis,and the relationship between nutritional index and hematopoietic reconstitution was clarified;5.ROC curve was used to analyze the risk prediction ability of nutritional status comprehensive index(nutritional index model),and the largest point of Youden index was used as the cutoff point(diagnostic threshold)to distinguish malnutrition.Result 1.340 cases of hematopoietic stem cell transplantation met the inclusion criteria,including 271 cases of successful hematopoietic reconstruction,accounting for 79.7%,69 cases of failure/poor hematopoietic reconstruction,accounting for 20.3%.2.Univariate analysis:disease type,transplantation mode,pretreatment mode,number of grafted CD34+cells and nutritional indicators(BMI,serum albumin,triacylglycerol,total cholesterol,total lymphocyte,red blood cell,hemoglobin)before hematopoietic stem cell transplantation were statistically significant between patients with hematopoietic success and patients with hematopoietic failure/malady.3.Logistic regression analysis showed that the number of CD34+ cells,transplantation mode and pre transplantation nutrition index(NI)were independent factors of hematopoietic reconstitution.4.ROC curve analysis:the area under ROC curve is 0.792(P<0.001),and the 95%confidence interval of the total area under ROC curve is 0.723-0.861,indicating that the preoperative nutrition index(NI)can be used to predict the failure/adverse risk of hematopoietic reconstitution.5.When NI=12.732,there is the largest Youden index,and the corresponding sensitivity and specificity are 0.825 and 0.656,respectively.Therefore,the diagnostic threshold of NI for predicting hematopoietic reconstitution can be 12.732.Conclusion 1.Nutritional status before hematopoietic stem cell transplantation is an independent factor of hematopoietic reconstitution.2.The preoperative nutrition index can be used as an index to predict the failure/risk of hematopoiesis reconstruction.3.The diagnostic threshold(cutoff point)of nutritional index model of hematopoietic stem cell transplantation patients is 12.732.When it is less than 12.732,doctors are advised to pay attention to nutritional status and intervene as early as possible.