Moreira-Pinto J, Leão I, Palmela C, Branco F, Godinho J, Simões P, Leal-Costa L, Lopes F, Faria A, Casa-Nova M, Escária A, Costa F, Galvão I, Teixeira J, Passos-Coelho JL. Febrile Neutropenia in Patients with Solid Tumors Undergoing Intravenous Chemotherapy.
Oncol Res Treat 2020;
43:605-612. [PMID:
32818937 DOI:
10.1159/000506109]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION
Febrile neutropenia (FN) is a potentially life-threatening complication of systemic chemotherapy (CT) that often requires hospital admission. Delay in diagnosis and treatment are associated with higher morbidity and mortality.
OBJECTIVE
We aimed to determine the factors that influence FN episodes outcomes in the emergency room (ER).
METHODS
This was a retrospective study of all FN episodes (with a collected blood culture [BC]) that occurred between 2012 and 2016 at our institution. FN was defined as a temperature ≥38°C and an absolute neutrophil count (ANC) <1,000/μL, expected to decrease to <500/μL in the following week.
RESULTS
Between 2012 and 2016, there were 173 FN episodes in 153/1,947 patients treated with intravenous CT. Most of these episodes (n = 121, 70%) were diagnosed in the ER, 29 in the outpatient clinic, and 23 as inpatients. In the ER, the median time was 36 min from hospital nurse triage to medical observation, and 52 min from medical observation to complete blood count specimen collection. There was a positive BC in 33 FN episodes, 72% with Gram-negative bacteria. A total of 160 FN episodes led to hospital admission and 13 were treated as outpatients. Mortality associated with the FN episode was 15% and an ANC <100/μL was predictive of increased mortality.
CONCLUSION
This study confirms that FN is a serious and common complication of IV CT which must be diagnosed and treated promptly. Profound neutropenia was the only predictive factor of mortality.
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