Treatment outcomes in patients with febrile neutropenia progressing to a critical condition

Abstract

Purpose. To determine the spectrum of febrile neutropenia (FN) complications resulting in critical conditions in patients receiving anti-tumor therapy, and to assess the immediate results of intensive care. Materials and Methods . This was an observational single-center study with 103 patients, who developed postcytostatic therapy febrile neutropenia progressing to a critical condition. Eligibility criteria included: anti-tumor therapy received within 29 days prior to admission to the Department of Critical and Intensive Care (DCIC) and complicated by FN; critical illness existing on admission or developing within 24 hours of admission to the DCIC; age over 16 years. Recorded data included demographics, vital signs, and test results obtained during the first 24 hours of treatment, which were required to evaluate the severity of adverse events in accordance with the Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE v5.0), the Systemic Inflammatory Response Syndrome (SIRS) criteria and the Sequential Organ Failure Assessment (SOFA) score; 30-day mortality and the subsequent anti-tumor therapy start date. Results. Out of 5114 admissions of 3608 patients, 114 met the eligibility criteria of the study, and all necessary data were obtained for 103 subjects. Patients with solid tumors accounted for two thirds of the study sample. The mean time from start of chemotherapy to critical condition was found to be 12.64±5.61 days. In 96% of the cases, the reason for hospitalization was a suspected systemic infection leading to organic disorders. Infection was the actual cause of the critical condition only in 48.5% of cases. The inpatient mortality rate was 31%; more than 70% of survivors continued anti-tumor therapy. Conclusion. The need to determine the cause of organic disorders, which often result from causes other than infection or sepsis as it is currently understood, is among the factors complicating the management of cancer patients whose critical condition is due to drug-induced febrile neutropenia and organ failure. The availability of intensive care ensures high short-term survival and enables further use of appropriate anti-tumor treatment.