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. 2021 Aug;23(4):e13588.
doi: 10.1111/tid.13588. Epub 2021 Mar 1.

D-index as a marker of bloodstream infections in patients with allogeneic hematopoietic stem cell transplantation

Prakhar Vijayvargiya  1   2 , Cybele Lara Abad  3 , Zerelda Esquer Garrigos  1   2 , John C O'Horo  1 , Randall C Walker  1 , William J Hogan  4 , Aaron J Tande  1
Affiliations

D-index as a marker of bloodstream infections in patients with allogeneic hematopoietic stem cell transplantation

Prakhar Vijayvargiya et al. Transpl Infect Dis. 2021 Aug.

Abstract

Background: Neutropenia is a risk factor for development of infections; however, the direct effect of neutropenia on development of bloodstream infection (BSI) is not known. D-index, which is area between the neutrophil time curve and a neutrophil count of 0.5 × 109 /L, incorporates the combined effect of severity and duration of neutropenia. We aimed to evaluate whether D-index can be used as a marker for BSI in patients with allogeneic stem cell transplantation.

Method: We conducted a retrospective cohort study of patients undergoing allogeneic stem cell transplantation between January 1, 2005, and September 30, 2015. The primary outcome measure was the development of BSI within 30 days of transplantation.

Results: A total of 714 patients were included in the study of whom 101 developed BSI. Patients with BSI had a significantly higher median D-index value compared with patients who did not have BSI (4990 vs. 3570, P < .001). As a marker, the performance of the D-index was similar to that of the duration of profound neutropenia (P = .18) and significantly better than the total duration of neutropenia (P = .001).

Conclusion: The D-index performed better than the total duration of neutropenia as a marker for BSI in patients with allogeneic stem cell transplantation. There was no difference between D-index and, a more easily calculable indicator, duration of profound neutropenia.

Keywords: D-index; allogeneic hematopoietic stem cell transplantation; bacteremia; bloodstream infection; neutropenia.

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Conflict of interest statement

Potential conflicts of interest. The authors declare no competing financial interests.

Figures

Figure 1:
Figure 1:
D-index is the area over the neutrophil curve and expresses the neutrophil deficit. Adapted from Kimura et al. [11]. This figure is available under the Creative Commons CC-BY-NC-ND license. Copyright © 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. Abbreviations: Ae, expected area under the curve; Ao, observed area under the curve.
Figure 2:
Figure 2:
Screening of the Hematopoietic Stem Cell Transplantation (HSCT) Cohort. Abbreviations: HSCT, hematopoietic stem cell transplantation; IFI, invasive fungal infection.
Figure 3.
Figure 3.
Pathogens Identified from Bloodstream Infections.
Figure 4.
Figure 4.
Receiver operating characteristic curves comparing the D-index0 (red) and D-index (green) with the duration of neutropenia (blue) and profound neutropenia (orange) until the development of a bloodstream infection. Abbreviations: AUC, Area under the curve. *P values represent the comparison between the two indices.
See this image and copyright information in PMC

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