Risk Factors Analysis Of Delayed Platelet Implantation After Allogeneic Hematopoietic Stem Cell Transplantation And Construction Of Nomogram Prediction Model

Backgroud:Allogeneic hematopoietic stem cell transplantation is the only possible way to cure a variety of malignant hematological diseases,but the disease can not be cured after transplantation,and many complications after transplantation will affect the survival prognosis of patients,which deserves our attention.Delayed platelet implantation after transplantation is one of the common post-transplant complications,and the delay in platelet implantation after transplantation will seriously affect the survival and prognosis of patients,and is one of the causes of death in many patients after transplantation.It has been previously reported that factors affecting the delay of platelet implantation after transplantation include infection,CD34+cell infusion,and the occurrence of graft-versus-host disease,which may lead to its occurrence.Serum ferritin is an acute-phase reactive protein that can be elevated by tumors,inflammation,infection,etc.In systemic inflammatory diseases,ferritin levels are closely related to inflammatory activity,and we found that ferritin is also elevated in some patients early after hematopoietic stem cell transplantation.Therefore,in order to further investigate whether elevated ferritin is an influencing factor in platelet implantation delay,we conducted a retrospective analysis and attempted to establish a predictive model that can predict platelet implantation delay after transplantation.Methods:We first screened the data of 170 patients who received allogeneic hematopoietic stem cell transplantation from January 2018 to August 2021 from the Department of Hematology,Zhujiang Hospital,Southern Medical University,and then used SPSS statistical software to perform univariate analysis to study the correlation between elevated ferritin after transplantation and patients with delayed platelet implantation.More factors affecting platelet implantation delay were included for analysis,and the relevant factors of P<0.1 were further included in the Logistics multivariate regression analysis to obtain independent risk factors for platelet implantation delay.Based on the results of Logistics multivariate regression analysis,the nomogram prediction model is constructed by R language software,and the prediction accuracy of the model is evaluated by the area under the curve(AUC)of the ROC curve and the calibration curve.Results:Through the analysis of 170 patients in our center,we concluded that the number of CD34+cell transfusions<5×106/kg(95%CI,1.202～14.324)(P=0.024),CMV reactivation(95%CI,2.140～78.425)(P=0.005),post-transplantation ferritin level≥ 2641 ng/mL(95%CI,0.27～0.702)(P=0.017)is an independent risk factor for delayed platelet implantation after transplantation.On this basis,we successfully constructed a nomogram prediction model for platelet implantation delay after transplantation.Through verification,we obtain AUC=0.815,and the absolute error value of the model predicting the risk of delayed platelet implantation after transplantation and the actual risk is 0.028.This means that our predictive model’s ability to predict post-transplant platelet implantation delay is in good agreement with actual occurrence.Conclusion:Our study identified 3 factors associated with delayed platelet implantation after transplantation,of which elevated ferritin after transplantation is a new finding in addition to the common influencing factors previously reported.Based on this,we constructed a reliable nomogram prediction model that can predict the probability of delayed platelet implantation events after transplantation,which lays a foundation for future research on the prevention and treatment of post-transplantation thrombocytopenia diseases.