Predischarge blood count and nutritional risk marker patterns associated with 30-day unplanned readmissions for hematological toxicity after radiotherapy for nasopharyngeal carcinoma: a multicenter cohort study.
4 affiliations
- 1School of Nursing, Youjiang Medical University for Nationalities, Baise, Guangxi, China.
- 2Department of Oncology, People's Hospital of Qianxinan Prefecture, Guizhou Province, China.
- 3Faculty of Medicine, Imperial College London, London, United Kingdom.
- 4Cardiac Intensive Care Unit, Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China.
Abstract
Early unplanned readmissions after radiotherapy-based treatment may reflect residual toxicity and gaps in supportive care coordination. We examined associations between predischarge hematological and albumin marker patterns and 30-day hematological toxicity-related unplanned readmission in nasopharyngeal carcinoma (NPC). This multicenter retrospective cohort study included 607 patients discharged after hospitalization involving radiotherapy-based treatment at three tertiary hospitals in southwestern China between December 2018 and March 2026. The primary complete-case sample comprised 588 patients with predischarge absolute neutrophil count (ANC), platelet count (PLT), and albumin measurements. Core markers were ANC <1.5 × 10⁹/L, PLT <200 × 10⁹/L, and albumin <35 g/L. We used association rule mining and Firth penalized logistic regression. Chemotherapy and supportive care variables were examined in sensitivity analyses, and all-cause 30-day unplanned readmission was a supportive secondary outcome. Based on the chronologically first readmission within 30 days, 77 of 607 patients (12.7%) were classified as having an unplanned readmission; 58 of the 77 (75.3%) were classified as hematological toxicity-related. In the primary sample, hematological readmission rates were 4.9%, 13.1%, and 17.5% for zero, one, and two or more core markers, respectively. Adjusted odds ratios (ORs) were 2.86 [95% confidence interval (CI) 1.50-5.46] and 4.33 (95% CI 1.82-10.30) for one and two or more markers versus zero markers. Corresponding ORs were 2.93 and 4.55 after chemotherapy adjustment and 2.59 and 3.47 after supportive care adjustment. The all-cause analysis showed a similar gradient (OR 2.65, 95% CI 1.52-4.61; OR 3.18, 95% CI 1.43-7.05). Routine predischarge measures were associated with early readmission risk, but the findings do not establish causality or a clinical decision rule. Prospective external validation is required before clinical use.
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BibTeX
@article{zhou2026predischarge,
title = {{Predischarge blood count and nutritional risk marker patterns associated with 30-day unplanned readmissions for hematological toxicity after radiotherapy for nasopharyngeal carcinoma: a multicenter cohort study.}},
author = {Guifei Zhou and Qianxi Sha and Lihong Zhao and Suren Rao Sooranna and Ying Wang and Huiying Tan},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1929774},
url = {https://europepmc.org/article/MED/42952952},
note = {CC BY},
}
RIS
TY - JOUR
TI - Predischarge blood count and nutritional risk marker patterns associated with 30-day unplanned readmissions for hematological toxicity after radiotherapy for nasopharyngeal carcinoma: a multicenter cohort study.
AU - Guifei Zhou
AU - Qianxi Sha
AU - Lihong Zhao
AU - Suren Rao Sooranna
AU - Ying Wang
AU - Huiying Tan
PY - 2026
DA - 2026/10/14
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1929774
UR - https://europepmc.org/article/MED/42952952
AB - Early unplanned readmissions after radiotherapy-based treatment may reflect residual toxicity and gaps in supportive care coordination. We examined associations between predischarge hematological and albumin marker patterns and 30-day hematological toxicity-related unplanned readmission in nasopharyngeal carcinoma (NPC). This multicenter retrospective cohort study included 607 patients discharged after hospitalization involving radiotherapy-based treatment at three tertiary hospitals in southwestern China between December 2018 and March 2026. The primary complete-case sample comprised 588 patients with predischarge absolute neutrophil count (ANC), platelet count (PLT), and albumin measurements. Core markers were ANC <1.5 × 10⁹/L, PLT <200 × 10⁹/L, and albumin <35 g/L. We used association rule mining and Firth penalized logistic regression. Chemotherapy and supportive care variables were examined in sensitivity analyses, and all-cause 30-day unplanned readmission was a supportive secondary outcome. Based on the chronologically first readmission within 30 days, 77 of 607 patients (12.7%) were classified as having an unplanned readmission; 58 of the 77 (75.3%) were classified as hematological toxicity-related. In the primary sample, hematological readmission rates were 4.9%, 13.1%, and 17.5% for zero, one, and two or more core markers, respectively. Adjusted odds ratios (ORs) were 2.86 [95% confidence interval (CI) 1.50-5.46] and 4.33 (95% CI 1.82-10.30) for one and two or more markers versus zero markers. Corresponding ORs were 2.93 and 4.55 after chemotherapy adjustment and 2.59 and 3.47 after supportive care adjustment. The all-cause analysis showed a similar gradient (OR 2.65, 95% CI 1.52-4.61; OR 3.18, 95% CI 1.43-7.05). Routine predischarge measures were associated with early readmission risk, but the findings do not establish causality or a clinical decision rule. Prospective external validation is required before clinical use.
SN - 2296-858X
ER -