Clinical Characteristics and Associated Factors of Mortality in Febrile Neutropenia Patients; a Cross Sectional Study
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
Introduction: The duration and severity of neutropenia directly correlate with the incidence of life-threatening infections. This study aimed to evaluate the clinical characteristics and associated factors of mortality in febrile neutropenia patients.
Method: This retrospective cross sectional study was conducted on all febrile neutropenia patients who were admitted to oncology department of two educational hospitals, Tehran, Iran, from 2011 to 2016. Available patientsâ€™ data regarding baseline characteristics, treatment, and outcome were collected and analyzed using SPSS 21.
Results: 357 patients with the mean age of 50.9Â±17.7 years were studied (59.7% female). Mean white blood cell count of the studied patients was 715.1 Â± 270.4 (100 â€“ 1400) cells/mm3. The absolute neutrophil count (ANC) of all patients was <500 cells/mm3. The most frequent sources of malignancy in studied patients were gastrointestinal (35.9%), breast (22.4%), and sarcoma (15.7%), respectively. The mean time interval between initiation of treatment in ED and increase of ANC to > 500 cells/mm3 was 2.45 Â± 2.1 (1 â€“ 16) days. 186 (52.1%) subjects reached ANC>500 cells/ mm3 after 2-5 days of hospitalization. The rate of hospital mortality was 5.3% (338 (94.7%) survived). The correlation between gender (p = 0.11), temperature (p = 0.123), number of ED visits (p = 0.765), presenting clinical manifestation (p = 0.201), source of malignancy (p= 0.328), presence of metastasis (p = 0.69), positive urine culture (p = 0.45), positive blood culture (p = 0.62), time from last chemotherapy (p = 0.677), and time to reach ANC>500 cells/mm3 (p = 0.739) with mortality wasÂ not significant.
Conclusion: Based on the findings of the present study, the rate of hospital mortality in patients with febrile neutropenia was 5.3%. Older age and lower white blood cell count were among the significant associated factors of mortality in this series.
- Chemotherapy-induced febrile neutropenia
- risk factors
How to Cite
Lehrnbecher T, Phillips R, Alexander S, Alvaro F, Carlesse F, Fisher B, et al. Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. Journal of clinical oncology. 2012;30(35):4427-38.
Santolaya M, Alvarez A, Acuna M, AvilÃ©s C, Salgado C, Tordecilla J, et al. Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial. Clinical Microbiology and Infection. 2017;23(3):173-8.
El Haddad H, Chaftari A-M, Hachem R, Micheal M, Jiang Y, Yousif A, et al. Procalcitonin Guiding Antimicrobial Therapy Duration in Febrile Cancer Patients with Documented Infection or Neutropenia. Scientific reports. 2018;8(1):1099.
Hemming V, Jakes AD, Shenton G, Phillips B. Prospective cohort study of procalcitonin levels in children with cancer presenting with febrile neutropenia. BMC pediatrics. 2017;17(1):2.
Bradbury PA, Morris DG, Nicholas G, Tu D, Tehfe M, Goffin JR, et al. Canadian Cancer Trials Group (CCTG) IND211: A randomized trial of pelareorep (Reolysin) in patients with previously treated advanced or metastatic non-small cell lung cancer receiving standard salvage therapy. Lung Cancer. 2018;120:142-8.
Baden LR, Swaminathan S, Angarone M, Blouin G, Camins BC, Casper C, et al. Prevention and treatment of cancer-related infections, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. 2016;14(7):882-913.
Segel GB, Halterman JSJPir. Neutropenia in pediatric practice. 2008;29(1):12.
Boragina M, Patel H, Reiter S, Dougherty GJPb, cancer. Management of febrile neutropenia in pediatric oncology patients: a Canadian survey. 2007;48(5):521-6.
Lyman GH, Michels SL, Reynolds MW, Barron R, Tomic KS, Yu J. Risk of mortality in patients with cancer who experience febrile neutropenia. Cancer. 2010;116(23):5555-63.
Chen Y, Wang Y, Shi Y, Dai G. Timing of chemotherapy-induced neutropenia predicts prognosis in metastatic colon cancer patients: a retrospective study in mFOLFOX6-treated patients. BMC cancer. 2017;17(1):242.
Ahn S, Lee Y-S. Predictive factors for poor prognosis febrile neutropenia. Current opinion in oncology. 2012;24(4):376-80.
Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106(10):2258-66.
Basu SK, Fernandez ID, Fisher SG, Asselin BL, Lyman GH. Length of stay and mortality associated with febrile neutropenia among children with cancer. Journal of clinical oncology. 2005;23(31):7958-66.
Tumbarello M, Spanu T, Caira M, Trecarichi EM, Laurenti L, Montuori E, et al. Factors associated with mortality in bacteremic patients with hematologic malignancies. Diagnostic microbiology and infectious disease. 2009;64(3):320-6.
Adnan A. Evaluation of the results of body fluid production in patients with fever and neutropenia from 2000 to 2005 in Sina Hospital, Hamedan. Journal of Hamadan University of Medical Sciences. 2005;3(2):12-20.
FOTOUKIAN Z, KEYHANIAN S, GHAFARI F, KHABIRI N, SARAVI M. COMPARISON THE EFFICACY OF CEFTAZIDIME AND IMIPENEM IN TREATMENT OF NEUTROPENIC FEBRILE DUE TO CHEMOTHERAPY IN CANCER PATIENTSV. 2009.
Lakshmaiah KC, Malabagi AS, Govindbabu RS, Sinha M, Jayashree RS. Febrile neutropenia in hematological malignancies: clinical and microbiological profile and outcome in high risk patients. Journal of laboratory physicians. 2015;7(2):116.
Hosseini M. Frequency and causes of fever in patients admitted with fever and neutropenia. Journal of Ilam University of Medical Sciences. 2004;1(4):12-8.
Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur A. Etiology and clinical course of febrile neutropenia in children with cancer. Journal of pediatric hematology/oncology. 2009;31(9):623.
Tamai Y, Imataki O, Kawakami K. Fever profile of febrile neutropenia in patients treated with cancer chemotherapy for hematological malignancies. Gan to kagaku ryoho Cancer & chemotherapy. 2010;37(5):859-62.
CortÃ©s JA, Cuervo S, GÃ³mez CA, BermÃºdez D, MartÃnez T, Arroyo PJB. Febrile neutropenia in the tropics: A description of clinical and microbiological findings and their impact on inappropriate therapy currently used at an oncological reference center in Colombia. 2013;33(1):70-7.
Stern A, Carrara E, Bitterman R, Yahav D, Leibovici L, Paul MJCDoSR. Early discontinuation of antibiotics for febrile neutropenia versus continuation until neutropenia resolution in people with cancer. 2019(1).
Malik I. Comparison of Meropenem with Ceftazidime as Monotherapy of Cancer Patients with Chemotherapy induced Febrile Neutropenia. JOURNAL-PAKISTAN MEDICAL ASSOCIATION. 2002;52(1):15-7.
Rolston KV, Berkey P, Bodey GP, Anaissie EJ, Khardori NM, Joshi JH, et al. A comparison of imipenem to ceftazidime with or without amikacin as empiric therapy in febrile neutropenic patients. Archives of internal medicine. 1992;152(2):283-91.
Meropenem Study Group of Leuven L, Nijmegen. Equivalent efficacies of meropenem and ceftazidime as empirical monotherapy of febrile neutropenic patients. Journal of Antimicrobial Chemotherapy. 1995;36(1):185-200.
GenÃ§er S, SalepÃ§i T, Ã–zer S. Evaluation of infectious etiology and prognostic risk factors of febrile episodes in neutropenic cancer patients. Journal of Infection. 2003;47(1):65-72.
El-Mahallawy H, Sidhom I, El-Din NA, Zamzam M, El-Lamie M. Clinical and microbiologic determinants of serious bloodstream infections in Egyptian pediatric cancer patients: a one-year study. International journal of infectious diseases. 2005;9(1):43-51.
Soroush J, Razavi S, Nojoomi M. COMPARING TWO EMPIRIC ANTIBIOTIC REGIMENS IN TREATMENT OF FEBRILE NEUTROPENIC CANCER PATIENTS. Razi Journal of Medical Sciences. 2003;10(36):547-52.
- Abstract Viewed: 246 times
- PDF Downloaded: 231 times
- HTML Downloaded: 49 times