Mortality, Length of Stay, and Cost Associated with Hospitalized Adult Cancer Patients with Febrile Neutropenia

Abstract

Background: Febrile neutropenia (FN) is a serious complication following chemotherapy and is associated with significant mortality and financial expenditure. The aim of this study was to evaluate risk factors for longer length of stay (LOS) and mortality and cost of treatment among hospitalized adults with cancer who developed febrile neutropenia in Thailand. Materials and Methods: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data covered 96% of the population and were analyzed by age groups, hospital level, and insurance year schemes in patients with febrile neutropenia. Results: A total of 5,809 patients were identified in the study. The mortality rate was 14%. The median LOS was 8.67 days and 69% of patients stayed for longer than 5 days. On bivariate analysis, age, cancer type, and infectious complications (bacteremia/sepsis, hypotension, fungal infections, and pneumonia) were significantly associated with longer LOS and death. On multivariate analysis, acute leukemia and infectious complications were linked with longer LOS and death significantly. The median cost of hospitalized FN was THB 33,686 (USD 1,122) with the highest cost observed in acute leukemia patients. Conclusions: FN in adult patients results in significant mortality in hospitalized Thai patients. Factors associated with increased mortality include older age (>70), acute leukemia, comorbidity, and infectious complications.

Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia; retrospective study of impact of combination antimicrobial therapy

“…There are several reports that a clinical presentation of sepsis is a strong predictor of mortality consistent with the present study [7,13,21]. As neutropenia may be a factor for increased mortality in patients with hematologic or solid malignancy, we analyzed the relationship between adequacy of antibiotic therapy and mortality after stratifying the cases in our study according to the presence of neutropenia [10,22]. Our results demonstrated that adequate combination antimicrobial therapy was associated with a decreased mortality rate in patients with neutropenia.…”

Hematologic Toxicity in Patients Undergoing Radical Anti-cancer Therapy: A Cross-Sectional Analysis of Patients in an Oncology Ward in India

“…A similar study on febrile neutropenic patients from Thailand showed an overall mortality rate of 14% (Chindaprasirt et al, 2013) while in our cohort it was around 5%. The above study was done on patients with leukaemia and undergoing hematopoietic stem cell transplantation (Ghosh et al, 2012).…”

Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients

“…Most important factors for risk groups are severity and duration of neutropenia, and presence of complications. Not being in remission, using high-dose chemotherapy protocols, the presence of severe mucositis, multiorgan failure shock,leukemia are also considered high-risk factors (Blot et al, 1997;Paesmans et al, 2000;Chindaprasirt et al, 2013). Recently, satisfying results with monotherapy in high-risk groups were also informed (Viscoli et al, 2006).…”