Febrile neutropenia in patients with acute myeloid leukemia: Outcome in relation to qSOFA score, C‐reactive protein, and blood culture findings

Abstract

Objectives: To evaluate quick Sequential Organ Failure Assessment (qSOFA) score during febrile neutropenia (FN) in adult patients receiving intensive chemotherapy for acute myeloid leukemia (AML). Methods: qSOFA score, as well as the association of qSOFA score with ICU admission, infectious mortality, blood culture findings, and C-reactive protein (CRP) measurements during FN were assessed among 125 adult AML patients with 355 FN periods receiving intensive chemotherapy in a tertiary care hospital from November 2006 to December 2018. Results: The multivariate model for qSOFA score ≥ 2 included CRP ≥ 150 mg/L on d0-2 [OR 2.9 (95% CI 1.1-7.3), P = .026], Gram-negative bacteremia [OR 2.7 (95% CI 1.1-6.9), P = .034], and treatment according to AML-2003 vs more recent protocols [OR 2.7 (95% CI 1.0-7.4), P = .047]. Age or gender did not gain significance in the model. qSOFA score ≥ 2 was associated with ICU treatment and infectious mortality during FN with sensitivity and specificity of 0.700 and 0.979, and 1.000 and 0.971, respectively. Conclusion: qSOFA offers a useful tool to evaluate the risk of serious complications in AML patients during FN.

The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

“…Age, multidrug resistant (MDR) organism, time to chemotherapy initiation, and comorbidities have variable effect on mortality in AML induction. 20,[36][37][38] In our study, on the univariate analyses, age, sex, symptoms duration, performance status, comorbidity, blood culture positivity, or organ localization had no significant effect on outcome. Days to develop FN were inversely associated with OS, though there was no statistically significant difference in OS.…”

Outcomes and Risk Factors of Critically Ill Patients with Hematological Malignancy. Prospective Single-Centre Observational Study

“…Despite this, we found that a qSOFA score ≥ 2 was independently associated with ICU mortality. In a study that analyzed AML patients with febrile neutropenia, a qSOFA score ≥ 2 was also associated with infectious mortality and was a good predictor of mortality when combined with C-reactive protein [21]. A study of cancer patients that included 23.4% of patients with hematological malignancies found that a qSOFA score ≥ 2 is associated with higher risk of hospital mortality and a prolonged ICU stay [22].…”

Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance

“…The qSOFA score is based in 3 simple variables, which include respiratory rate ≥22/min, alteration in mental status, and systolic blood pressure ≤100 mm Hg (96). The SOFA and qSOFA scores are therefore useful tools to identify and predict complications and mortality in these patients (97)(98)(99), and as such, should be applied to all cancer patients with suspected infection.…”