[Predictive value of the endothelial activation and stress index combined with the serum albumin concentration for the prognosis of bloodstream infection in patients with hematologic neoplasms].

Objective: To investigate the prognostic utility of the endothelial activation and stress index (EASIX) combined with the serum albumin concentration in patients with hematologic neoplasms complicated by bloodstream infection (BSI). Methods: This single-center retrospective cohort study analyzed the clinical data of patients with hematologic neoplasms and comorbid BSI admitted to the Department of Hematology of the Affiliated Hospital of Xuzhou Medical University between January 2020 and June 2023. Patients were categorized into survivor and non-survivor groups based on 30-day mortality post-BSI diagnosis. Univariate analysis was used to compare clinical indicators between groups, while multivariate logistic regression was employed to identify independent prognostic factors. The predictive efficacy of the EASIX and serum albumin was evaluated using receiver operating characteristic (ROC) curve analysis. Results: A total of 221 BSI patients were included [113 males (51.1%), 108 females (48.9%)], with a median age of 54 (40, 64) years. The survivor group comprised 158 patients (71.5%) and the non-survivor group 63 patients (28.5%). Univariate analysis revealed that the non-survivor group had significantly higher EASIX scores [3.92 (2.87, 6.05)] and lactate dehydrogenase levels [341 (222, 918) U/L] than the survivor group [2.37 (1.12, 3.93) and 216 (146, 330) U/L, respectively] (both P<0.001). Non-survivors presented with lower hemoglobin levels [63 (57, 72) g/L vs. 70 (58, 96) g/L; P<0.05] and significantly lower platelet counts [16 (10, 30)×109/L vs. 27 (12, 75)×109/L] and serum albumin concentrations [30.9 (27.8, 34.2) g/L vs. 36.6 (32.9, 39.9) g/L] (both P<0.01). Multivariate logistic regression confirmed that both the EASIX score (OR=1.401, 95%CI 1.161 to 1.691, P<0.001) and the serum albumin concentration (OR=0.851, 95%CI 0.782 to 0.926, P<0.001) are independent prognostic factors. ROC curve analysis yielded an area under the curve (AUC) of 0.717 (95%CI 0.642 to 0.792) for the EASIX in predicting mortality, and an AUC of 0.764 (95%CI 0.701 to 0.827) for serum albumin. Their combined use increased the AUC to 0.803 (95%CI 0.744 to 0.863), with a sensitivity of 93.4%. Conclusions: Elevated EASIX scores and hypoalbuminemia serve as independent predictors of a poor prognosis in patients with hematologic neoplasms complicated by BSI. The combined detection of both indicators significantly improves predictive efficacy and may facilitate early clinical risk stratification.