{
  "abstract": "Background/Objectives: Infection is a major complication of acute myeloid leukaemia (AML) induction, and analyses relating treatment-emergent infection to survival are prone to immortal-time bias. We characterised baseline and treatment-emergent infection during induction and used bias-aware methods to distinguish a pre-treatment risk signal from a survival-time artefact. Methods: Our study analysed a retrospective single-centre cohort of 91 adults with newly diagnosed AML receiving induction under universal posaconazole prophylaxis (2019–2025) with Cox models, 14- and 30-day landmark analyses and Firth penalised logistic regression. Results: Active infection at diagnosis occurred in 23/91 (25.3%) and treatment-emergent infection in 54/91 (59.3%). A naive Cox model showed an implausibly protective association for treatment-emergent infection (hazard ratio [HR] 0.46, 95% CI 0.21–0.99). In 14- and 30-day landmark analyses (HR 0.59 and 0.60; 95% CIs included 1) the estimate moved toward the null and lost statistical significance; because infection-onset dates were unavailable, landmark analysis only partially corrects this bias, and the independent association between treatment-emergent infection and survival could not be reliably estimated. Active infection at diagnosis showed a fragile, exploratory association with later mortality that was nominally significant in only one of several pre-specified specifications (30-day landmark HR 2.56, 95% CI 1.03–6.37). Conclusions: The apparently protective association of treatment-emergent infection with survival is consistent with immortal-time bias; it is a complication and marker of course, not a survival determinant. Baseline infection is a hypothesis-generating candidate pre-treatment risk marker that requires prospective validation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hematology, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, 16310 Bursa, Turkey",
    "Department of Internal Medicine, Antalya Training and Research Hospital, 07100 Antalya, Turkey",
    "Department of Hematology, Faculty of Medicine, Bursa Uludağ University, 16059 Bursa, Turkey",
    "Department of Hematology, Antalya Training and Research Hospital, 07100 Antalya, Turkey"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hilmi Erdem Gözden",
      "orcid": "0000-0002-4194-007X"
    },
    {
      "affs": [
        1
      ],
      "name": "Halime Betül Tokat"
    },
    {
      "affs": [
        1
      ],
      "name": "Hamide Tuğba Uluçay"
    },
    {
      "affs": [
        1
      ],
      "name": "Fatma Tuğçe Bayrak"
    },
    {
      "affs": [
        1
      ],
      "name": "Recep Kaya"
    },
    {
      "affs": [
        1
      ],
      "name": "Alperen Burak Kocabıyık",
      "orcid": "0009-0002-6948-7147"
    },
    {
      "affs": [
        1
      ],
      "name": "Süleyman Emre Okutan"
    },
    {
      "affs": [
        2
      ],
      "name": "İbrahim Ethem Pınar",
      "orcid": "0000-0001-9907-1498"
    },
    {
      "affs": [
        3
      ],
      "name": "Erdal Kurtoğlu"
    },
    {
      "affs": [
        3
      ],
      "name": "Volkan Karakuş",
      "orcid": "0000-0001-9178-2850"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8aapkh1h069yf.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15207841",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705091/?tool=EBI",
  "id": "8aapkh1h069yf",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/7841",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2730|Neutropenia and Cancer Infections"
    ]
  ],
  "openalex": "W7221513994",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705091/pdf/?tool=EBI",
  "pmcid": "PMC13705091",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/8aapkh1h069yf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15207841",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/7841"
    },
    {
      "first_seen": "2026-10-30T12:21:25Z",
      "native_id": "PMC:PMC13705091",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13705091"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Neutropenia and Cancer Infections",
      "subfield": "oncology"
    }
  ],
  "title": "Infectious Burden and Immortal-Time Bias During AML Induction: A Supportive-Care Cohort Under Posaconazole Prophylaxis",
  "title_text": "Infectious Burden and Immortal-Time Bias During AML Induction: A Supportive-Care Cohort Under Posaconazole Prophylaxis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:25Z",
  "url": "https://research.draconitic.com/paper/8aapkh1h069yf",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}