Clinical and Treatment-Related Factors Associated with Neutrophil Recovery After Bloodstream Infection in Acute Leukemia: A Competing-Risk Analysis.
- 1Department of Hematology and Internal Medicine, Military Institute of Medicine-National Research Institute, 128 Szaserów Street, 04-141 Warsaw, Poland.
- 2Department of Laboratory Diagnostics, Military Institute of Medicine-National Research Institute, 128 Szaserów Street, 04-141 Warsaw, Poland.
Abstract
Background/objectives
Neutrophil recovery after bloodstream infection (BSI) in acute leukemia is clinically important, but evaluation is complicated by early death and recurrent infectious episodes. We assessed clinical, treatment-related, and microbiological factors associated with recovery while accounting for death as a competing event.Methods
This retrospective single-center cohort included 205 microbiologically documented BSI episodes in 101 adults with acute leukemia treated between 2020 and 2025. Neutrophil recovery was defined as an absolute neutrophil count >500/µL after BSI onset. The endpoint was evaluable in 186 episodes; 116 were followed by recovery and 70 by death before recovery. Recurrent episodes were retained and within-patient dependence was addressed by patient-level clustering in marginal Fine-Gray regression.Results
In the fully adjusted model (177 episodes, 93 patients), G-CSF use was associated with a higher cumulative incidence of recovery (sHR 3.17, 95% CI 1.40-7.18; p = 0.006), as was consolidation versus induction (sHR 2.50, 95% CI 1.44-4.33; p = 0.001). Clinically relevant antimicrobial resistance was not independently associated with recovery (sHR 0.80, 95% CI 0.38-1.68; p = 0.558). A literal-first-BSI sensitivity analysis supported the overall clinical pattern.Conclusions
Neutrophil recovery after BSI was associated primarily with treatment and clinical context, while the crude adverse association with antimicrobial resistance was substantially attenuated after adjustment. These observational associations, particularly those involving G-CSF, should not be interpreted causally.
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BibTeX
@article{gawronski2026clinical,
title = {{Clinical and Treatment-Related Factors Associated with Neutrophil Recovery After Bloodstream Infection in Acute Leukemia: A Competing-Risk Analysis.}},
author = {Krzysztof Gawronski and Nadia Hussein and Piotr Rzepecki and Aneta Guzek},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193234},
url = {https://europepmc.org/article/MED/42882927},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical and Treatment-Related Factors Associated with Neutrophil Recovery After Bloodstream Infection in Acute Leukemia: A Competing-Risk Analysis.
AU - Krzysztof Gawronski
AU - Nadia Hussein
AU - Piotr Rzepecki
AU - Aneta Guzek
PY - 2026
DA - 2026/10/08
JO - Cancers
DO - 10.3390/cancers18193234
UR - https://europepmc.org/article/MED/42882927
AB - Background/objectives Neutrophil recovery after bloodstream infection (BSI) in acute leukemia is clinically important, but evaluation is complicated by early death and recurrent infectious episodes. We assessed clinical, treatment-related, and microbiological factors associated with recovery while accounting for death as a competing event.Methods This retrospective single-center cohort included 205 microbiologically documented BSI episodes in 101 adults with acute leukemia treated between 2020 and 2025. Neutrophil recovery was defined as an absolute neutrophil count >500/µL after BSI onset. The endpoint was evaluable in 186 episodes; 116 were followed by recovery and 70 by death before recovery. Recurrent episodes were retained and within-patient dependence was addressed by patient-level clustering in marginal Fine-Gray regression.Results In the fully adjusted model (177 episodes, 93 patients), G-CSF use was associated with a higher cumulative incidence of recovery (sHR 3.17, 95% CI 1.40-7.18; p = 0.006), as was consolidation versus induction (sHR 2.50, 95% CI 1.44-4.33; p = 0.001). Clinically relevant antimicrobial resistance was not independently associated with recovery (sHR 0.80, 95% CI 0.38-1.68; p = 0.558). A literal-first-BSI sensitivity analysis supported the overall clinical pattern.Conclusions Neutrophil recovery after BSI was associated primarily with treatment and clinical context, while the crude adverse association with antimicrobial resistance was substantially attenuated after adjustment. These observational associations, particularly those involving G-CSF, should not be interpreted causally.
SN - 2072-6694
ER -