https://orcid.org/0000-0002-2959-0978
Key Points
Triple A is a reliable tool for predicting survival and thrombosis in ET, and incorporating monocytosis may further enhance its performance.
NLR might serve both as independent risk marker and as component of NLR-monocyte-age based model for predicting survival.
The management of essential thrombocythemia (ET) relies on risk stratification; therefore, easily applicable risk scores with improved prognostic value are in demand. Triple A risk score (AAA model) is a novel model incorporating Age, Absolute neutrophil, and Absolute lymphocyte counts. In this study, we aimed to evaluate the predictive performance of Triple A score in ET for survival and its complications in an independent cohort, in addition to refining the model by incorporating absolute monocyte count and neutrophil/lymphocyte ratio (NLR). Demographic, clinical, and laboratory data of 565 ET patients were retrospectively collected. Based on Triple A score, 250 patients were classified as low-, 228 as intermediate-1, 37 as intermediate-2, and 50 as high-risk. Over a median follow-up of 6 years, 10.3% patients developed thrombosis, 4.4% experienced bleeding, 5.1% had post-ET myelofibrosis, and 10.9% died. There were significant differences in overall survival (p<0.001) and thrombosis-free survival (p=0.0003) across risk groups. Monocytosis (>800 x 106/L) was associated with increased mortality (p=0.033) and its prevalence increased progressively with higher Triple A scores (p<0.001). Elevated NLR was also linked to a higher risk of mortality (p<0.001), and moreover, NLR-monocyte-age based risk score demonstrated significant differences in survival risk (p<0.0001). Consequently, Triple A score is an easy-to-use and reliable tool for predicting survival and thrombosis in ET. Incorporating monocytosis into Triple A (AAA+A model) may further enhance its prognostic accuracy. NLR also demonstrated prognostic value both independently and as component of NLR-monocyte-age based model, highlighting its potential as a robust tool for risk stratification.
