Prognostic value of pre-transplant inflammatory and albumin-based composite ratios for pneumonia and mortality after allogeneic hematopoietic stem cell transplantation

Özlem Düvenci Birben; Esma Sevil Akkurt; Derya Yenibertiz; Bilal Çağdaş Seven; Tahir Darçın; Bahar Uncu Ulu; Dicle İskender; Tuğçe Nur Yiğenoğlu; Mehmet Sinan Dal; Fevzi Altuntaş

Prognostic value of pre-transplant inflammatory and albumin-based composite ratios for pneumonia and mortality after allogeneic hematopoietic stem cell transplantation

Abstract

Aims: Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are highly susceptible to infectious complications due to immunosuppression and delayed immune reconstitution, with pneumonia remaining a major cause of early morbidity and mortality. Composite inflammation- and protein-based biomarkers, including the C-reactive protein-to-albumin ratio (CAR) and fibrinogen-to-albumin ratio (FAR), have prognostic value in oncology, but their role in predicting pneumonia and survival after allo-HSCT is unclear. Methods: This retrospective, single-center study included 203 adult allo-HSCT recipients treated between 2020 and 2023. Pre transplant inflammatory and protein-based biomarkers were assessed 7-14 days before transplantation, and Cox proportional hazards regression was used to identify independent predictors of one-year post-transplant pneumonia and mortality. Results: Pneumonia occurred in 17.7% of patients, and one-year mortality was 41.9%. Although lower albumin, hemoglobin, and platelet levels and higher procalcitonin (PCT) concentrations were associated with pneumonia in univariate analyses, no biomarker independently predicted post-transplant pneumonia after multivariate adjustment. In contrast, pre-transplant PCT (HR=1.020, p<0.001) and total protein (HR=0.929, p=0.002), along with male sex and underlying diagnosis, independently predicted one-year mortality. CAR and FAR were associated with mortality only in univariate analyses. Conclusion: Pre-transplant inflammatory and protein-based biomarkers reflect biological vulnerability in allo-HSCT recipients. Although none independently predicted post-transplant pneumonia, PCT and total protein predicted one-year mortality, suggesting that systemic inflammatory burden and baseline protein status are more informative for long-term prognosis than for infection risk. Incorporating these markers into multifactorial models may improve pre-transplant risk stratification.

Keywords

Supporting Institution

none

Ethical Statement

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the University of Health Sciences, Ankara Oncology Training and Research Hospital Ethics Committee (Approval No: 2025-12/185). Written informed consent was obtained from all participants prior to transplantation and for the use of anonymized clinical data for scientific analysis.

References

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Details

Primary Language

English

Subjects

Respiratory Diseases, Chest Diseases

Journal Section

Research Article

Authors

Özlem Düvenci Birben ^*
0009-0002-3631-6819
Türkiye

Esma Sevil Akkurt
0000-0002-5416-3783
Türkiye

Derya Yenibertiz
0000-0002-1783-4015
Türkiye

Bilal Çağdaş Seven
0009-0001-8210-2320
Türkiye

Tahir Darçın
0000-0001-5073-1790
Türkiye

Bahar Uncu Ulu
0000-0002-6230-9519
Türkiye

Dicle İskender
0000-0002-6062-6422
Türkiye

Tuğçe Nur Yiğenoğlu
0000-0001-9962-8882
Türkiye

Mehmet Sinan Dal
0000-0003-0788-9853
Türkiye

Fevzi Altuntaş
0000-0001-6872-3780
Türkiye

Publication Date

May 22, 2026

Submission Date

February 25, 2026

Acceptance Date

April 25, 2026

Published in Issue

Year 2026 Volume: 8 Number: 3

IZ

https://izlik.org/JA45PT84KL

Cite

RIS / Bibtex

APA

Düvenci Birben, Ö., Akkurt, E. S., Yenibertiz, D., Seven, B. Ç., Darçın, T., Uncu Ulu, B., İskender, D., Yiğenoğlu, T. N., Dal, M. S., & Altuntaş, F. (2026). Prognostic value of pre-transplant inflammatory and albumin-based composite ratios for pneumonia and mortality after allogeneic hematopoietic stem cell transplantation. Anatolian Current Medical Journal, 8(3), 504-512. https://izlik.org/JA45PT84KL

AMA

1.Düvenci Birben Ö, Akkurt ES, Yenibertiz D, et al. Prognostic value of pre-transplant inflammatory and albumin-based composite ratios for pneumonia and mortality after allogeneic hematopoietic stem cell transplantation. Anatolian Curr Med J / ACMJ / acmj. 2026;8(3):504-512. https://izlik.org/JA45PT84KL

Chicago

Düvenci Birben, Özlem, Esma Sevil Akkurt, Derya Yenibertiz, et al. 2026. “Prognostic Value of Pre-Transplant Inflammatory and Albumin-Based Composite Ratios for Pneumonia and Mortality After Allogeneic Hematopoietic Stem Cell Transplantation”. Anatolian Current Medical Journal 8 (3): 504-12. https://izlik.org/JA45PT84KL.

EndNote

Düvenci Birben Ö, Akkurt ES, Yenibertiz D, Seven BÇ, Darçın T, Uncu Ulu B, İskender D, Yiğenoğlu TN, Dal MS, Altuntaş F (May 1, 2026) Prognostic value of pre-transplant inflammatory and albumin-based composite ratios for pneumonia and mortality after allogeneic hematopoietic stem cell transplantation. Anatolian Current Medical Journal 8 3 504–512.

IEEE

[1]Ö. Düvenci Birben et al., “Prognostic value of pre-transplant inflammatory and albumin-based composite ratios for pneumonia and mortality after allogeneic hematopoietic stem cell transplantation”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 3, pp. 504–512, May 2026, [Online]. Available: https://izlik.org/JA45PT84KL

ISNAD

Düvenci Birben, Özlem - Akkurt, Esma Sevil - Yenibertiz, Derya - Seven, Bilal Çağdaş - Darçın, Tahir - Uncu Ulu, Bahar - İskender, Dicle - Yiğenoğlu, Tuğçe Nur - Dal, Mehmet Sinan - Altuntaş, Fevzi. “Prognostic Value of Pre-Transplant Inflammatory and Albumin-Based Composite Ratios for Pneumonia and Mortality After Allogeneic Hematopoietic Stem Cell Transplantation”. Anatolian Current Medical Journal 8/3 (May 1, 2026): 504-512. https://izlik.org/JA45PT84KL.

JAMA

1.Düvenci Birben Ö, Akkurt ES, Yenibertiz D, Seven BÇ, Darçın T, Uncu Ulu B, İskender D, Yiğenoğlu TN, Dal MS, Altuntaş F. Prognostic value of pre-transplant inflammatory and albumin-based composite ratios for pneumonia and mortality after allogeneic hematopoietic stem cell transplantation. Anatolian Curr Med J / ACMJ / acmj. 2026;8:504–512.

MLA

Düvenci Birben, Özlem, et al. “Prognostic Value of Pre-Transplant Inflammatory and Albumin-Based Composite Ratios for Pneumonia and Mortality After Allogeneic Hematopoietic Stem Cell Transplantation”. Anatolian Current Medical Journal, vol. 8, no. 3, May 2026, pp. 504-12, https://izlik.org/JA45PT84KL.

Vancouver

1.Özlem Düvenci Birben, Esma Sevil Akkurt, Derya Yenibertiz, Bilal Çağdaş Seven, Tahir Darçın, Bahar Uncu Ulu, Dicle İskender, Tuğçe Nur Yiğenoğlu, Mehmet Sinan Dal, Fevzi Altuntaş. Prognostic value of pre-transplant inflammatory and albumin-based composite ratios for pneumonia and mortality after allogeneic hematopoietic stem cell transplantation. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 May 1;8(3):504-12. Available from: https://izlik.org/JA45PT84KL