Abstract
(1) Background: Neutropenic enterocolitis (NEC) is a life-threatening complication following chemotherapy with high mortality rates. Early diagnosis is crucial to improve outcomes. We designed a large prospective study employing bedside ultrasonography (US) as a novel approach to allow early diagnosis and prompt treatment to reduce mortality. (2) Methods: NEC was defined as US or computed tomography (CT)-proven bowel wall thickness ≥ 4 mm at the onset of at least one of the following symptoms: fever and/or abdominal pain and/or diarrhea during neutropenia. From 2007 to 2018, 1754 consecutive patients underwent baseline bedside US that was invariably repeated within 12 h from the onset of symptom(s) suggestive of NEC. (3) Results: Overall, 117 episodes of NEC were observed, and overall mortality was 9.4%. Bowel wall thickening was invariably absent in the negative control group. Abdominal pain associated with one or more symptoms correlated with the highest relative risk (17.33), sensitivity (89.7%), specificity (100%), and accuracy (96.2%) for diagnosis. The combination of abdominal pain and fever at onset significantly correlated with worse survival (p < 0.0001, OR 13.85). BWT (p = 0.046), type of therapy (p = 0.049) and blood culture positivity (p = 0.003) correlated with worse survival. (4) Conclusions: Bedside ultrasound is a non-invasive and radiation free imaging technique for early diagnosis of NEC and its prompt treatment significantly reduced mortality.
Highlights
Neutropenic enterocolitis (NEC) is a life-threatening clinical syndrome [1,2,3], characterized by fever, abdominal pain, and diarrhea during neutropenia
Between March 2007 and January 2018, 1754 consecutive adult patients admitted to the Division of Hematology and to the Bone Marrow Transplant Unit of the University of Pisa, Italy, experiencing chemotherapy-related neutropenia were prospectively enrolled in our study
NEC developed after a median of 4 days of chemotherapy-related neutropenia
Summary
Neutropenic enterocolitis (NEC) is a life-threatening clinical syndrome [1,2,3], characterized by fever, abdominal pain, and diarrhea during neutropenia. It is primarily observed in patients with hematological malignancies [4,5], but it has been described in solid tumors and AIDS [2,6,7]. We present a novel prospective study where non-invasive and cost-effective bedside ultrasound monitoring allowed early diagnosis and guided prompt medical treatment [3,11,17] resulting in significantly reduced mortality
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