Establishment and Application of Warning Scoring System for Bleeding Severity in Patients with Newly Diagnosed Acute Promyelocytic Leukemia.

Abstract

Create and evaluate a scoring system to detect early moderate/severe bleeding in acute promyelocytic leukemia (APL).MethodsThe study used 89 APL patients from Shanxi Bethune Hospital (2014/01-2024/10) for development and 48 APL patients from Tianjin Medical University General Hospital (2021/08-2024/08) for validation. Logistic regression was used to analyze independent risk factors and develop a scoring system based on odds ratios, with ROC curves assessing the AUC. Both sets were classified into low and high risk using the system's cut-off, and the incidence of moderate/severe bleeding in each group was calculated. The scoring system's relationship with the ISTH DIC score and their combined diagnostic efficacy for DIC and bleeding events in APL patients were evaluated using AUC, specificity, and sensitivity.ResultsIn the development cohort, 15.7% (14 cases) had moderate/severe bleeding, while the validation cohort had 14.6% (7 cases). Multivariate logistic regression identified LDH levels ≥538 IU/L, fibrinogen <0.95 g/L, and D-Dimer ≥6865 ng/mL as independent risk factors for early moderate/severe bleeding in APL patients. The new warning scoring system had an AUC of 0.899 in the development group and 0.937 in the validation group. High-risk patients in both cohorts were significantly more likely to experience moderate/severe bleeding than low-risk patients (p < .001). The ISTH DIC score is significantly linked to both bleeding severity and the warning scoring system.ConclusionsThe warning scoring system shows potential for predicting the risk of moderate/severe bleeding in APL patients; however, further prospective validation studies are necessary to substantiate its efficacy.