The evaluation of mucositis in patients treated with high-dose chemotherapy with Autologous stem cell support and its role in evaluation of oral intake and other factors of morbidity and mortality


Klin Onkol 2001; 14(3): 96-101.

Abstract: Background: MUCPEAK is a simple scoring system for evaluation of oral mucositis. High scores of MUCPEAK has been shown to predict the risk of bacteremia and peritransplant mortality in recipients of autologous or allogene progenitor blood cell transplants. However, its corre1ation with oral intake and other factors of mucositis has not been evaluated prospectively. Methods: From September 1999 to September 2000, 21 ASCT patients were evaluated for signs of GIT mucositis. MUCPEAK, nausea, vomiting, diarrhoe, Culi blood counts and oral intake were evaluated daily; as adequate oral intake was taken ˇÝ 50% of 1.25x resting energy expenditure (REE). Spearman correlation coefficients and Mantel-Haenszel chi-square tests were used. Results: MUCPEAK showed significant negative correlation with oral intake (r= -0.36, p = 0.0003).
However, oral intake correlated significantly also with absolute neutrophil count (ANC, r = 0.37, P = 0.00003), and nausea/vomiting (r = -0.34, P = 0.0001) with strong correlation also betwen MUCPEAK and ANC (r = -0.56, P <0.00001). The corelation of MUCPEAK and nausea/vomiting was of much less significance (r = 0.2, P = 0.01). MUCPEAK score > 10 or > 12; or ANC <500 or <1000/mm3 could all be used as powerful predictors of inadequate oral intake on a given dar (odds ratios 5.88, 7.69,5.34 and 5.42; p = 0.000003, 0.001, <0.000001 and <0.000001). Number of days with MUCPEAK >12 correlated significantly with lenght of hospitalization after PBPC infusion (r = 0.471, P = 0.05). Patients with peritransplant febrile episodes had more severe mucositis than patients who did not became febrile (maximum MUCPEAK 13.8 v. 11.4, P <0.001) and onset of fever correlated strongly with MUCPEAK score (p = 0.007). However, consumption of blood products was not dependent on severity of mucositis. Conclusion: MUCPEAK is a powerful predictor of adequacy of oral nutritional intake, probability of infection and lenght of hospitalization in ASCT patients. MUCPEAK is strongly dependent of ANC count bul only modestly correlates with other signs of GIT mucositis. MUCPEAK score of>10 or >12 and ANC <500 or <1000 predict an inadequate oral intake on a given day and can be used for indentification of candidates for nutritional intervention.

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