Development of an early warning score scale for cyclosporine-related encephalopathy after hematopoietic stem cell transplantation and its application
Objective To develop an modified early warning score(MEWS)scale to assess cyclosporine(CsA)-related encephalopathy after hematopoietic stem cell transplantation(HSCT),and to explore its application.Methods A total of 125 patients with CsA-related encephalopathy treated with CsA after HSCT from January 2017 to January 2022 were selected as the study objects.The cutoff point was found out using the MEWS.On the basis of the original MEWS,the newly developed scale was created by adding parameters of CsA and albumin(ALB).Assignment and assessment of the reliability and validity were performed.A new version of MEWS was then established to accurately help medical staff to identify CsA-related encephalopathy at an early stage.Using the new version of MEWS,the cutoff point of 27 patients with CsA-related encephalopathy who were treated with CsA after HSCT from February 2022 to July 2022 was calculated.Intervenes were given according to the evaluation results.The incidence of CsA-related encephalopathy was recorded.Results Univariate analysis confirmed that heart rate,systolic blood pressure,respiratory rate,body temperature,consciousness,blood concentration of CsA and Alb were all significantly related with CsA-related encephalopathy after HSCT(P＜0.05).Logistic regression analysis confirmed that heart rate,systolic blood pressure,respiratory rate,body temperature,consciousness,blood concentration of CsA and Alb were all independent factors affecting the new version of MEWS in distinguishing CsA-related encephalopathy after HSCT(P＜0.05).Evaluator reliability test showed a correlation between the test object and the evaluator,with an intraclass correlation coefficient(ICC)of 0.904(95％confidence interval[CI]0.823,0.978),indicating a reliability of the new version of MEWS in distinguishing CsA-related encephalopathy after HSCT.Internal consistency test of new version of MEWS showed the total Cronbach's α of 0.867,and the Cronbach's α of each item was good(0.815-0.859).The correlation coefficient between the coefficient of each item and the total score of the new version of MEWS was 0.452-0.925(P＜0.05),indicating that each item could achieve the evaluation purpose.The average content validity ratio(CVR)of the six items in the new version of MEWS was 0.880,and exploratory factor analysis showed that the items were well structured.The results of principal component analysis(PCA)showed that the generating characteristic values of common factors heart rate and systolic blood pressure were greater than 1,which could explain 78.652％of the total variance.Among 125 patients with treated with CsA after HSCT,16.80％had CsA-related encephalopathy.The new version of MEWS was used to evaluate the incidence of CsA-related encephalopathy in 27 patients with CsA after HSCT from February 2022 to July 2022.After an early warning intervention(medical intervention),the incidence of CsA-related encephalopathy was 3.70％,which was significantly lower than that of CsA-related encephalopathy(16.80％)reported from January 2017 to January 2022(P＜0.05).Conclusion Compared with the original MEWS,the new version of MEWS has higher sensitivity and accuracy,and a good predictive effect on reducing the prevalence of CsA-related encephalopathy after HSCT.It is beneficial to the follow-up treatment of CsA-related encephalopathy.
stem cell transplantationcyclosporine-related encephalopathymodified early warning score scaleformulation and application
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