Download PDF
CC BY-NC-ND 4.0 · South Asian J Cancer 2017; 06(01): 025-027
DOI: 10.4103/2278-330X.202565
ORIGINAL ARTICLE: Supportive Care

Epedimiologic, clinical profile and factors affecting the outcome in febrile neutropenia

Kalpathi Krishnamani
Department of Medical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana,
,
Linga Vijay Gandhi
Department of Medical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana,
,
Gundeti Sadashivudu
Department of Medical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana,
,
Digumarti Raghunadharao
Director, Homi Bhabha Cancer Hospital & Research Centre, Aganampudi, Visakhapatnam 530053, Andhra Pradesh, India
› Author Affiliations Source of Support: Nill.
› Further Information
Also available at
  PDF Download Permissions and Reprints

Abstract

Background: Febrile neutropenia (FN) is common in cancer patients particularly hematologic malignancies due to intensive cytotoxic chemotherapy. It is an important cause of morbidity, mortality and treatment delays. The risk is greater in patients with ANC < 500/ mm3 and increases dramatically in those with ANC < 100/ mm3 and duration of neutropenia more than 1 week. Aims and Objectives: The purpose of this study was to evaluate the incidence, demographic characteristics, clinical profile, mortality, outcome and factors affecting the outcome in patients with febrile neutropenia (FN) admitted at our Center between January 2011 and November 2012. Materials and Methods: All cases of FN admitted in our Institute between January 2011 and November 2012 were analyzed. Data was analyzed using IBM statistic SPSS version 19. Results: A total of 333 episodes of FN were reviewed. Hematologic malignancies accounted for 299 (89.7%) episodes and 88% of all the episodes had grade 4 neutropenia. There was a significant association noted between high serum bilirubin, creatinine and outcome. Isolation of an organism from blood culture, positive findings on chest X-ray and fungal infection was associated with higher mortality . Association between transfusion requirements and outcome was analyzed and it was observed that patients who had multiple component transfusions vs single component ones were at a significantly higher risk of death. There were only 7 deaths noted among the patient population. Conclusion: Leukemias are the leading cause of FN at our Institute. Higher bilirubin, creatinine, chest imaging favoring pneumonia, positive isolates and multiple transfusions had significant association with mortality. Large scale prospective studies are needed to determine the association of preemptive therapy with higher mortality. The outcome of high risk FN in this study is favorable.

Key words

Epidemiology - febrile neutropenia - outcome


Publication History

Article published online:
22 December 2020

© 2017. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. https://creativecommons.org/licenses/by-nc-nd/4.0/.

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Harousseau JL, Witz B, Lioure B, Hunault-Berger M, Desablens B, Delain M, et al. Granulocyte colony-stimulating factor after intensive consolidation chemotherapy in acute myeloid leukemia: Results of a randomized trial of the group oust-est leucemies aigues myeloblastiques. J Clin Oncol 2000;18:780-7.
  • 2 Au E, Ang PT. Management of chemotherapy-induced neutropenic sepsis – Combination of cephalosporin and aminoglycoside. Ann Acad Med Singapore 1993;22:319-22.
  • 3 Wong GC, Tan BH. Use of antibiotics in a haematology ward – An audit. Ann Acad Med Singapore 2008;37:21-6.
  • 4 Jin J, Lee YM, Ding Y, Koh LP, Lim SE, Lim R, et al. Prospective audit of febrile neutropenia management at a tertiary university hospital in Singapore. Ann Acad Med Singapore 2010;39:453-9.
  • 5 Viscoli, Claudio, Oliviero Varnier, and Marco Machetti. “Infections in patients with febrile neutropenia: Epidemiology, microbiology, and risk stratification.” Clinical Infectious Diseases 40. Supplement 4 (2005): S240-S245.
  • 6 Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006;106:2258-66.
  • 7 Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 2000;18:3038-51.
  • 8 André S, Taboulet P, Elie C, Milpied N, Nahon M, Kierzek G, et al. Febrile neutropenia in French emergency departments: Results of a prospective multicentre survey. Crit Care 2010;14:R68.
  • 9 Roy V, Saxena D, Agarwal M, Bahadur AK, Mishra B. Use of antimicrobial agents and granulocyte colony stimulating factors for febrile neutropenia in cancer patients in a tertiary care hospital in India. Indian J Cancer 2010;47:430-6.
  • 10 Timothy M, Bodkyn C. The outcome of febrile neutropenic episodes in paediatric oncology at the Wendy Fitzwilliam Paediatric Hospital. West Indian Med J 2011;60:153-7.
  • 11 Kanamaru A, Tatsumi Y. Microbiological data for patients with febrile neutropenia. Clin Infect Dis 2004;39 Suppl 1:S7-S10.
  • 12 Gaytán-Martínez J, Mateos-García E, Sánchez-Cortés E, González-Llaven J, Casanova-Cardiel LJ, Fuentes-Allen JL. Microbiological findings in febrile neutropenia. Arch Med Res 2000;31:388-92.
  • 13 Jadhav MP, Shinde VM, Chandrakala S, Jijina F, Menon H, Arora B, et al. A randomized comparative trial evaluating the safety and efficacy of liposomal amphotericin B (Fungisome) versus conventional amphotericin B in the empirical treatment of febrile neutropenia in India. Indian J Cancer 2012;49:107-13.
  • 14 Johnson MD, MacDougall C, Ostrosky-Zeichner L, Perfect JR, Rex JH. Combination antifungal therapy. Antimicrob Agents Chemother 2004;48:693-715.