Study strengths and limitations
infection, AML, COD infection
INFECTION, AML, STILL
Strengths of the study included the size of the study population and the quality of the data which was prospectively collected during a randomized controlled trial. However, it should be considered that the cohort dates from 2006 and since then advances in diagnostics and treatment of IA as well as improvements in prophylactic strategies have been made. Still though, the competing risk analysis enabled us to study the effect of IA on mortality for each separate COD (’leukaemia’,’infection and other COD’ and’miscellaneous’). Furthermore, we focused on IA as COD in older patients with AML or high-risk MDS. Though there are some limitations. First, IA was described in the infection form, but in a small number of patients the diagnosis was uncertain. These cases were discussed and final decision was based on consensus. Secondly, no information was available about clinical characteristics, diagnostic tests that were performed, or the certainty of diagnosis. We were dependent on the diagnosis of IA that was made by the treating physician at the time and registered in the infection form. However, even though exact certainty of the diagnosis of IA could not be established in this cohort, as is more often the case in real-life clinical practice, the diagnosis (and treatment) of IA are usually not made and reported without consideration of host characteristics, imaging and clinical signs and symptoms. Thirdly, the COD was based on clinical diagnosis and not autopsy. In some cases, IA itself was the COD, but numbers are uncertain as COD infection was not always further specified. Fourthly, for modelling purposes different COD needed to be grouped together.