Predicting the complicated neutropenic fever in the emergency department

Abstract

Objectives:The purpose of this study was to identify independent factors that can be used to predict whether febrile neutropenic patients who appear healthy at presentation will develop subsequent complications, using variables that are readily available in the emergency department (ED).Method:The medical records of 192 episodes in which the patients presented to the ED with neutropenic fever resulting from chemotherapy, with an alert mental state and haemodynamic stability were retrospectively reviewed. Endpoints examined were fever response to administered antibiotics, death or severe medical complications during hospitalisation.Results:Thirty-eight episodes of neutropenic fever with complicated outcomes were identified from among a total of 192 episodes. Three parameters emerged as independent factors for the prediction of neutropenic fever with complications in the multivariate regression analysis: platelet count (130−450 × 103 cells/mm3) <50 000 cells/mm3, serum C-reactive protein (CRP, 0.1–1 mg/dl) >10 mg/dl and pulmonary infiltration on chest x ray.Conclusions:Platelet count, CRP and pulmonary infiltration on chest x ray at presentation could be used to identify febrile neutropenic patients who will develop complications, and these factors may be useful in making treatment-related decisions in the ED.

Diagnostic performance of procalcitonin, presepsin, and C‐reactive protein in patients with hematological malignancies

“…C‐reactive protein was reported to be useful for aiding treatment‐related decision‐making, and it was suggested that high CRP levels are associated with sepsis and microbiologically documented infections in patients with febrile neutropenia . However, it was subsequently reported that CRP is not very specific and hence is a poor diagnostic marker of infection in patients with febrile neutropenia .…”

Risk factors associated with complications in patients with chemotherapy‐induced febrile neutropenia in emergency department

“…Moon et al . aimed to predict complicated febrile neutropenia in the ED, finding that laboratory parameters such as platelet count, CRP, and pulmonary infiltration as revealed by chest x‐ray readily identified patients most likely to develop complications . CRP, an indicator of inflammation, is sensitive in predicting febrile neutropenia, especially in the presence of shock and hematologic malignancies .…”

Prognostic factors for risk stratification of adult cancer patients with chemotherapy‐induced febrile neutropenia: A systematic review and meta‐analysis

“…It was not possible to undertake subgroup analysis for primary studies due to mixed patient groups data not being analysed separately (e.g. solid tumour and haematological malignancy data were combined) …”

“…The included studies comprised of four prospective and three retrospective cohort studies. Three studies analysed data according to repetitive episodes of FN, whereas the remainder analysed by study population. These studies were conducted in 20 countries.…”

“…Pooling of data for thrombocytopenia also involved two studies with a total of 588 episodes (514 patients) that showed a strong association with adverse outcomes (Fig. ) . Both were analysed using a fixed effect model with no heterogeneity detected between studies ( I 2 = 0%).…”