Abstract
Aim. The study aimed to describe the profile of Filipino febrile neutropenia patients and to determine parameters associated with severe outcomes. Methods. This is a retrospective study of Filipino febrile neutropenia patients admitted to the Philippine General Hospital. Patients were described in terms of clinical presentation and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using regression analysis. Results. 115 febrile episodes in 102 patients were identified. Regression analysis yielded prolonged fever >7 days prior to admission (OR 2.43; 95% CI, 0.77–7.74), isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04–6.98), and nadir absolute neutrophil count (ANC) < 100 during admission (OR 1.96; 95% CI, 0.75–5.12) as significant predictors of poor outcome. Factors that significantly correlated with better outcome were granulocyte colony-stimulating factor (G-CSF) use (OR 0.31; 95% CI, 0.11–0.85) and completeness of antibiotic therapy (OR 0.26; 95% CI, 0.10–0.67). Conclusion. Prolonged fever >7 days prior to admission, positive pathogen on cultures, and nadir ANC < 100 during admission predicted severe outcomes, whereas G-CSF use and complete antibiotic therapy were associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and monitoring.
Highlights
Febrile neutropenia refers to the presentation of fever in a neutropenic patient, commonly with an uncontrolled neoplasm of the bone marrow, or in a patient undergoing cytotoxic treatment [1]
The inclusion criteria consisted of patients >19 years old with a suspected or documented risk factor for febrile neutropenia who developed fever coexistent with or during the neutropenic episode; patients with existing severe infection prior to the onset of neutropenia were excluded
Stepwise logistic regression with backward selection strategy was employed on specific variables; the significance of the main effects of the different independent variables on severe outcomes was determined by univariate analysis to establish the strength of association of each independent variable and outcome variable
Summary
Febrile neutropenia refers to the presentation of fever in a neutropenic patient, commonly with an uncontrolled neoplasm of the bone marrow, or in a patient undergoing cytotoxic treatment [1]. Around 50% of patients with solid tumors and 80% of those with hematologic malignancies will develop concomitant fever and neutropenia [2]; despite advances in diagnostics and therapy, these patients still face a mortality rate of 5–21.5% [3,4,5]. This is partly explained by the fact that neutropenic patients who develop fever have a 60% chance of being infected. In the Philippines, a retrospective study showed Gram negative bacilli (51.5%) as the most frequently isolated pathogen [3]; in another study involving pediatric patients with malignancy and febrile neutropenia, the most common organisms were Streptococcus viridans, Gram negative bacilli, Staphylococcus epidermidis, Candida sp., and Salmonella sp. [13]
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