Abstract
Early intracranial hemorrhage (EICH), which is defined by noticeable ICH within 10 days of diagnosis, is a life-threatening hemorrhagic complication in patients with acute leukemia. To ascertain risk factors associated with EICH, we retrospectively analyzed 792 newly-diagnosed acute leukemia patients treated between July 1988 and March 2003. Thirty-one patients (3.9 %) had analyzable EICH. Multivariate analysis showed that female gender (OR = 3.064, P < 0.001), acute promyelocytic leukemia (OR = 8.797, P = 0.003), leukocytosis (OR = 6.056, P = 0.004), and prolonged prothrombin time (OR = 10.026, P = 0.016) were factors significantly associated with occurrence of EICH. Risk scores (RS) were calculated by a product of odds ratio and each risk factor (RF) and taking their sum, generating an RS ranging 0 to 27.943. The cutoff of RS 9 was of statistical significance to predict probability of EICH. Receiver-operating characteristics curve shows the sensitivity and 1 - specificity relative to risk score (AUC = 0.917; S.E. = 0.021; 95% CI, 0.876–0.958; Figure 1). In this regards, RF for EICH was classified as major (prolonged prothrombin time) and minor (female gender, acute promyelocytic leukemia, leukocytosis). Risk model demonstrated that EICH was low probable when no major RF and less than two minor RFs were present. Risk model for ICH in acute leukemia classified acute leukemia patients into two risk groups; low probable EICH group (LPG) and probable EICH group (PG). When applied to our patients, PG was positively correlated with more incidence of FICH than LPG (n = 27/173 vs. 4/619, P < 0.001). Induction chemotherapy could be undertook more frequently in LPG than in PG (p = 0.002, Table 1). Kaplan-Meier curves show the probability of EICH-free survival relative to probability of EICH. ICH-free survival was significantly longer in LPG than in PG (p < 0.0001, Figure 2). Our findings suggest that our risk model may predict the occurrence of EICH in patients with acute leukemia.
Table 1. The relationship of risk model and frequency of early intracranial hemorrhage (EICH) or performance of induction chemotherapy.
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Figure
| Low probable EICH group, n (%) | Probable EICH group, n (%) | P | |
|---|---|---|---|
| EICH (−) | 615 (77.7 %) | 146 (18.4 %) | < 0.001 |
| EICH (+) | 4 (0.5 %) | 27 (3.4 %) | |
| Induction chemotherapy (+) | 563 (71.1 %) | 143 (18.1 %) | 0.002 |
| Induction chemotherapy (−) | 56 (7.1 %) | 30 (3.8 %) |
| Low probable EICH group, n (%) | Probable EICH group, n (%) | P | |
|---|---|---|---|
| EICH (−) | 615 (77.7 %) | 146 (18.4 %) | < 0.001 |
| EICH (+) | 4 (0.5 %) | 27 (3.4 %) | |
| Induction chemotherapy (+) | 563 (71.1 %) | 143 (18.1 %) | 0.002 |
| Induction chemotherapy (−) | 56 (7.1 %) | 30 (3.8 %) |
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