Background: There is, until now, no prognostic grading system for infections occurring in allogeneic stem cell transplant (SCT) recipients. The aim of this study was to determine the prognostic value of a grading system of infectious complications in predicting death.
Methods: For the purposes of a prospective allogeneic SCT trial, we classified severity of infections in 3 grades according to expected rates of mortality (>or= 60% for grade 3). We prospectively recorded the type and time of occurrence of 440 infectious events in 190 consecutive patients until 6 months after transplant. We used multivariate Cox models with time-dependent covariates to analyze the relationship between the grade of severity of each infectious episode and mortality due or not due to infection, adjusting for possible confounders.
Results: Only patients with grade 3 infections had a significantly increased risk of death (P<.0001). The risk was not modified when the occurrence of acute graft-versus-host disease or the dose of IVIg administered were considered. Occurrence of a grade 1 and 2 infection had no additional influence.
Conclusion: Our grading system identifies the most medically important, life-threatening infections and allow high-risk patients to be identified. We suggest grade 3 infections should be given priority in the evaluation of anti-infectious strategies.