Clinical significance of monitoring urine BK polyomavirus in patients with hemorrhagic cystitis after hematopoietic stem cell transplantation / 中华检验医学杂志

ABSTRACT

Objective This study was aimed to analysis the relationship of BK polyomavirus ( BKV) and hemorrhagic cystitis ( HC ) in patients who received hematopoietic stem cell transplantation (HSCT).Methods Data of 80 patients who received HSCT and took regular urine test every week from June 2015 to April 2018 in the Third Xiangya Hospital of Central South University was retrospectively analyzed, they were 35 females and 45 males (aged 20-40 years, median age 30 years), and 31 cases with acute myeloid leukemia ( AML) , 24 cases with acute lymphoblastic leukemia ( ALL) , 15 cases with aplastic anemia ( AA ) , 4 cases with chronic myeloid leukemia ( CML ) , 6 cases with other diseases such as myelodysplastic syndrome ( MDS) in the study population.The positive rate and incidence of HC were analyzed.Patients who infected with the BK virus were divided into HC group and non -HC group according to occurrence of HC.BK viral load were compared in two groups .Urine BK viral load were analyzed after logarithmic transformation.Data that conforms to a normal distribution is expressed as mean ± standard deviation.t test, ANOVA and ROC curve were used to statistical analysis .Skewed data is expressed in median ( interquartile range ) , non-normal distribution parameters were compared by Wilcoxon test .Results Among 80 patients, 43 recipients (53.75％) became urinary BK positive, with 19 patients developed HC (23.75％), all of the 19 HC patients have urinary BK positive , and none of 37 BK-negative patients developed HC;the urine BKV level of the initial time and the peak time in HC group were (7.59 ±2.46) lg copy/ml, (10.56 ±1.71) lg copy/ml, the urine BKV level of the initial time and the peak time in non-HC group were (5.75 ±2.10) lg copy/ml,(7.31 ±2.29) lg copy /ml.The urine BKV level of the initial time and the peak time in HC group was higher than in non-HC group ( t=2.642, P=0.012 and t=5.147, P=0.000 respectively), when analyzing the urine BKV level of the initial time in HC group and non-HC group, the best threshold is 5.23 lg copy/ml(1.68 ×105 copy/ml),with a sensitivity of 84.20％and specificity of 54.17％, when analyzing the urine BKV level of the peak time in HC group and non-HC group, the best threshold is 9.75 lg copy/ml(5.62 ×109 copy/ml),with a sensitivity of 84.20％and specificity of 83.33％, area under curve of each other were 0.728 (95％ CI 0.575-0.881) and 0.875 (95％ CI 0.769-0.981) respectively.Conclusions The BK viral load is closely related with HC in HSCT patients .The cut-off level of 1.68 ×105 copy/ml when analyzing the urine BKV level of the initial time , and the cut-off level of 5.62 × 109 when analyzing the urine BKV level of the peak time , help to forecast or auxiliary diagnose HC .