Factors predicting the outcome in febrile neutropenia: A study from a tertiary cancer center in India.

Abstract

e20684 Background: Febrile neutropenia (FN) is common in patients undergoing chemotherapy. The risk dramatically increases in those with absolute neutrophil count (ANC) less than 100/ mm3. Methods: In this 2 year studyall FN patients admitted at our center between January 2011 and November 2012 were analyzed for clinical profile, microbiologic isolates, mortality and factors affecting outcome. IBM statistic SPSS version 19 was used to analyze the data. Results: There were 333 episodes of FN during the study period. Majority (89.7%) of FN episodes occurred in patients with hematologic malignancies and 87% of episodes had ANC< 500. Induction, consolidation and maintenance related episodes were 125 (37.5%), 125 (37.5%) and 17 (5.1%) respectively. First line antibiotics (cefipime, Cefaperazone- Sulbactum + aminoglycoside), second line antibiotics (carbapenam) and antifungals were used in 44.4%, 15.6 % and 34% episodes respectively. Gram negative organisms accounted for 51.6% of the isolates. Prognostic significance between mean serum bilirubin, serum creatinine and outcome was noted, with higher deaths in patients with bilirubin > 1.5 mg% (12.2% vs 0.7%) (p= 0.000) and creatinine > 1.2 mg% (16% vs 1%) (p=0.000). Isolation of an organism and infiltrates on chest X-ray had a significant association with outcome(p= 0.017 and 0.002) respectively. Patients who had multiple component transfusions vs single component ones were at a significantly higher risk of death ( 6 deaths vs 1)(p= 0.002). There were 20 (6%) possible,33 (10%) probable and 9 (2.7 %) proven fungal infections, with significant association with outcome (p=0.000). The risk of death in those with fungal infection was 14.323 (95%CI - 2.70-75.952). Preemptiveantifungal use had a higher percentage of prolonged (> 8 days) and profound neutropenia in contrast to the empirical group (77.2% vs 65.2%) and (91% vs 83.8%), resulting in 3 deaths in the preemptive group (6.8% vs 0%) (p=0.02). The overall mortality was 2.1%. Conclusions: Leukemias are the leading cause of FN at our Institute with 2.1% mortality. Higher bilirubin, creatinine, chest imaging favoring pneumonia, positive isolates and multiple transfusions had significant association with mortality.