2.1 Study population
The study population included a cohort of adult MHD patients at the Second Hospital of Anhui Medical University who had completed their first DSI assessment 6 months earlier (March 2022). Exclusion criteria were 1) inability to comprehend with the questionnaire content, 2) presence of comorbid malignancies and infections (including COVID-19) based on clinical/laboratory findings, and 3) inability to provide consent without a proxy. A second DSI assessment was performed for screened patients during lockdown(between October and November 2022). This study was approved by the Ethics Review Committee of the Second Affiliated Hospital of the Anhui Medical University (No. pj - yx2020 - 006). Before participation, all patients were required to read and sign an informed consent form.