Length of Stay and Mortality Associated With Febrile Neutropenia Among Children With Cancer

Basu, Swati; Fernandez, I. Diana; Fisher, Susan G.; Asselin, Barbara L.; Lyman, Gary H.

doi:10.1200/jco.2005.01.6378

Cited by 136 publications

(125 citation statements)

References 24 publications

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“…[13] In the current study, the risk of composite AE outcome was higher in children younger than 5 years compared to those who were older (61% vs. 39%; OR 1.83), although the result was not statistically significant (p=0.172).…”

Section: Resultscontrasting

confidence: 43%

“…A similar study reported three-fold longer length of stay as well as death in AML patients as compared to ALL [13]. A diagnosis of lymphoma and sarcomas was associated with a significant reduction in the risk of composite adverse outcome.…”

Section: Resultsmentioning

confidence: 64%

“…[11,15,16] A recently published study reported 11.1% composite AE outcome in FN patients with in-hospital mortality of (0.7%), PICU admission (4.7%), and fluid resuscitation > 40 ml/kg in (10.1%). [17] Out data also showed that severe myelosuppression was associated with composite AE outcome as patients with more severe neutropenia and thrombocytopenia have a higher risk for AE [13,21]. A diagnosis of sepsis or bacteremia conferred a 2.3-fold increase in the risk (13% vs. 29%; p=0.05) of composite AE.…”

Section: Discussionmentioning

confidence: 99%

“…There has been increasing interest in stratifying these patients into risk categories to establish guidelines for better management [7,[12][13][14]. The current study uses a single institution database to identify the risk factors for development of adverse outcomes among PCP with PFN.…”

Section: Discussionmentioning

confidence: 99%

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Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

Matloob¹

2016

Journal of Microbiology and Infectious Diseases

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Objective: Pediatric cancer patients with prolonged febrile neutropenia have increased risk for severe, recurrent or new bacterial and fungal infection. The aim of this study was to identify the risk factors associated with adverse outcomes in this group. Methods:We retrospective analyzed the clinical data of 135 hospitalizations of pediatric cancer patients with prolonged febrile neutropenia from a tertiary health care center of Pakistan. Results:The mean age of the study population was 7.3±4.1 years. There were 98 (72.6%) males and 37 (27.4%) females. Acute leukemia with 88 patients (65.2%) was the most common diagnosis followed by lymphomas 19 patients (14.1%) and solid tumors. Cause of febrile neutropenia was identified in only 58 (43.0%) patients, out of them blood stream infections were found in 22 cases (16.3%), pneumonia in 15 (11.1%), fungal infection in 13 (9.6%), infectious diarrheas in 5 (3.7%) and urinary tract infection (UTI) in 3 (2.2%) of cases. The composite adverse event outcome was observed in 28 (20.7%) of patients, with in-hospital mortality occurring in 7 (5.2%), Pediatric intensive care unit (PICU) admission occurring in 12 (8.9%) and inotropic support was required in 9 (6.7%). On logistic regression analysis AML (Adjusted odds ratio (AOR), 7.6; P<0.001), neutropenia <50/mm 3 (AOR, 10.8; p<0.001), platelets count <50,000/mm 3 (AOR, 5.2; p<0.001), BSI (AOR, 2.3; p 0.05) and fungal infection (AOR, 4.3; p<0.001) were found as independent risk factors for composite adverse event outcome in pediatric cancer patients with prolonged febrile neutropenia.Conclusions: AML, severe myelosuppression, blood stream infections and fungal infection were identifiable risk factors associated with development of adverse event outcome in pediatric cancer patients with prolonged febrile neutropenia. J Microbiol Infect Dis 2016;6(2): 69-73Key words: Febrile neutropenia, pediatric, oncology, adverse outcome Uzamış Febril Nötropeni ile Pediatrik Kanser Hastalarında Karma Olumsuz Durum SonuÖZET Amaç: Uzamış febril nötropeni pediatrik kanserli hastalarında ağır seyirli yeni tanı veya tekrarlayan bakteri ve mantar enfeksiyonu riski artmıştır. Bu çalışmanın amacı, bu grupta olumsuz sonuçlarla ilişkili risk faktörlerini belirlemektir.Yöntemler: Pakistan'ta bir üçüncü basamak sağlık merkezine uzamış febril nötropeni nedeni ile izlenen pediatrik kanser hastalarının 135 hastane yatış epizotu retrospektif olarak analiz edildi. Bulgular: Çalışma grubunun yaş ortalaması 7,3 ± 4,1 yıl idi. Hastaların 98'i (% 72,6) erkek ve 37'si (% 27,4) kadındı. Akut lösemi 88 hastada (% 65,2) ile birinci sırada, lenfoma 19 hasta (% 14,1) ile ikinci sırada idi ve diğer hastalarda solid organ tümörleri en sık görülen tanı olarak saptandı. Febril nötropenin nedeni sadece 58 (% 43,0) hastada tanımlandı. Bu hastalardan 22 olguda (% 16,3) kan akımı enfeksiyonu (KAE), 15 hastada pnömoni (% 11,1), fungal infeksiyon 13 (% 9,6) hastada, ve enfeksiyöz diyare 5 hastada (% 3,7) ve üriner sitem enfeksiyonu 3 (% 2,2) hastada saptandı. Karma olumsu...

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Section: Resultscontrasting

confidence: 43%

Section: Resultsmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

Matloob¹

2016

Journal of Microbiology and Infectious Diseases

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“…En estudios norteamericanos se encuentra que hasta el 34% de los casos de neutropenia febril corresponden a pacientes con leucemia linfoide aguda, seguido de leucemia mieloide aguda con un 11% y linfoma no Hodgkin con un 9%. Otros tumores en los cuales se ha reportado esta entidad son las neoplasias del sistema nervioso central en el 6%, riñón en el 3% y tumores gonadales 16 . Estudios realizados en Colombia muestran cifras similares, encontrando que el 47% de los casos de neutropenia febril corresponden a pacientes con leucemia linfoide aguda, linfoma no Hodgkin en el 21%, leucemia mieloide aguda en el 10% y menos frecuentemente en el tumor de Wilms, retinoblastoma, rabdomiosarcoma y tumores del sistema nervioso central 15 .…”

Section: Neutropeniaunclassified

Abordaje del paciente pediátrico con neutropenia febril y enfermedad oncológica

2015

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RESUMENIntroducción: La neutropenia febril en el paciente pediátrico con enfermedad oncológica es una situación frecuente asociada a la quimioterapia que lleva a una alta morbimortalidad. Su principal etiología es la infección, ameritando un estudio oportuno y completo para identificar el origen e instaurar un tratamiento de forma rápida y dirigida, por lo cual es necesario conocer sobre esta patología y su abordaje. Objetivo: Realizar una revisión actual y completa de esta patología, abordando su epidemiología, etiología, diagnóstico clínico y tratamiento. Metodología de búsqueda: Se realizó una búsqueda en bases de datos como Cochrane Library, Medscape, Pubmed, RIMA, Ebscohost, HINARI, Dynamed, NEJM, usando palabras clave como neutropenia, fiebre, infección, riesgo, neoplasia y tratamiento. Se seleccionaron principalmente guías de práctica clínica, revisiones sistemáticas y estudios clínicos aleatorios. Discusión: Esta situación se presenta principalmente en pacientes con neoplasias hematolinfoides y la causa de la fiebre se debe en primer lugar a una infección, cuyo agente etiológico varía según la procedencia del caso, el uso de catéteres intravenosos o si hay neutropenia profunda y prolongada. El abordaje diagnostico debe ser mediante un examen físico minucioso y el uso de herramientas como hemograma, reactantes de fase aguda y policultivos. El uso de modelos pronósticos para realizar estratificación del riesgo de complicaciones permite dirigir el manejo antibiótico que se va a instaurar. Conclusión: Mediante la mejoría del conocimiento de esta enfermedad, las estrategias de diagnóstico y tratamiento han podido mejorar la sobrevida y el pronóstico de los pacientes con esta patología. MÉD UIS. 2015;28(3):353-62.Palabras clave: Fiebre. Neutropenia. Neoplasias. Pediatría. Infección. Approach to the pediatric patient with febrile neutropenia and oncologic diseaseABSTRACT Introduction: Febrile neutropenia in pediatric patients with oncological disease, is a common condition leading to high morbidity and mortality. The main cause is infection, meriting a timely and comprehensive study to identify its source and begin an early and a targeted therapy, it is necessary to know about this disease and its management. Objective: Perform a current review of this pathology by addressing its epidemiology, etiology, clinical diagnosis and treatment. Methods: Search in database like Cochrane Library, Medscape, Pubmed, RIMA, Ebscohost, HINARI, Dynamed, NEJM, using keywords like neutropenia, fever, infection, risk, neoplasia and treatment. We selected clinical practice guidelines, systematic reviews and randomized clinical trials. Discussion: It is a common situation mainly in patients with hematological malignancy and the cause of the fever is due to an infection whose etiologic agent varies according to origin of the case, use of intravenous catheters or prolonged and deep neutropenia. The diagnostic approach must be through physical examination and the use of diagnostic tools such blood count, acute phase reactants and poly...

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Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients

Kuderer

Dale

Crawford

et al. 2006

Cancer

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BACKGROUNDHospitalization for febrile neutropenia (FN) in cancer patients is associated with considerable morbidity, mortality, and cost. The study was undertaken to better define mortality, length of stay (LOS), cost, and risk factors associated with mortality and prolonged hospitalization in cancer patients with FN.METHODSThe longitudinal discharge database derived from 115 US medical centers was used to study all adult cancer patients hospitalized with FN between 1995 and 2000, comprising a total of 41,779 patients. Primary outcomes included mortality, LOS, and cost per episode.RESULTSOverall, in‐hospital mortality was 9.5%. Patients without any major comorbidities had a 2.6% risk of mortality, whereas 1 major comorbidity was associated with a 10.3% and more than 1 major comorbidity with a ≥21.4% risk of mortality, respectively. Mean (median) length of stay was 11.5 (6) days, and the mean (median) cost was $19,110 ($8,376) per episode of FN. Patients hospitalized for ≥10 days (35% of all patients) accounted for 78% of overall cost. Independent major risk factors for inpatient mortality included invasive fungal infections, Gram‐negative sepsis, pneumonia and other lung disease, cerebrovascular, renal, and liver disease. Main predictors for LOS ≥10 days included leukemia, invasive fungal infections, other types of infection, and several comorbid conditions.CONCLUSIONFactors associated with increased mortality, LOS, and cost in hospitalized adult cancer patients with FN include patient characteristics, type of malignancy, comorbidities, and infectious complications. These factors may be useful in identifying patients at increased risk of serious medical complications and mortality for more aggressive supportive care measures. Cancer 2006. © 2006 American Cancer Society.

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Length of Stay and Mortality Associated With Febrile Neutropenia Among Children With Cancer

Cited by 136 publications

References 24 publications

Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

Composite Adverse Event Outcome in Pediatric Cancer Patients with Prolonged Febrile Neutropenia

Abordaje del paciente pediátrico con neutropenia febril y enfermedad oncológica

Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients

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