Prediction of Serious Complications in Patients With Seemingly Stable Febrile Neutropenia: Validation of the Clinical Index of Stable Febrile Neutropenia in a Prospective Cohort of Patients From the FINITE Study

Carmona-Bayonas, Alberto; Jiménez‐Fonseca, Paula; Echaburu, Juan Virizuela; Antonio, Maite; Font, Carme; Biosca, Mercedes; Ramchandani, Avinash; Martínez, Juan Pérez; Cubero, Jorge Hernando; Espinosa, Javier; Castro, Eva Martínez de; Ghanem, Ismael; Beato, Carmen; Blasco, Ana; Garrido, Marcelo; Bonilla, Yaiza; Mondéjar, Rebeca; Lanza, María Ángeles Arcusa; Manrique, Isabel Aragón; Manzano, Aránzazu; Sevillano, Elena; Castañón, Eduardo; Cardona, Mercè; Martín, Elena Gallardo; Armillas, Quionia Pérez; Lasheras, Fernando Sánchez; Peña, Francisco Ayala de la

doi:10.1200/jco.2014.57.2347

Cited by 127 publications

(100 citation statements)

References 23 publications

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“…In an attempt to assess the risk for complications in patients with febrile neutropenia, Carmona-Bayonas et al recently developed a new model to more accurately classify patients with cancer with seemingly stable febrile neutropenia episodes. 35 In spite of the apparently better outcomes for patients with solid tumors and febrile neutropenia, which allow management on an outpatient basis in many cases, the presence of a solid neoplasm as the underlying disease was found to be an independent risk factor associated with mortality in two studies involving cancer patients with BSI caused by MDR Gram-negative bacilli. 36,37 The information available regarding the initial empirical antibiotic therapy and outcomes of patients with solid tumors and BSI is detailed in Table 4.…”

Section: Etiology Of Bloodstream Infection In Patients With Solid Tumorsmentioning

confidence: 99%

Bloodstream infections in patients with solid tumors

2016

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Little information is currently available regarding bloodstream infection (BSI) in patients with solid tumors who, for a variety of reasons, are particularly predisposed to develop this condition. In this review we focus on the incidence, epidemiology, clinical features, etiology, antimicrobial resistance, and outcomes of BSI of adult cancer patients with solid tumors. Most episodes of BSI occur in nonneutropenic patients, in whom the site of primary or metastatic tumor often serves as the portal of entry. The urinary tract and the abdomen are the most frequent sources of infection, and cholangitis is the most common recurrent source of BSI. Gram-negative bacilli are becoming the leading cause of BSI in patients with solid tumors, and the rate of multidrug resistance is increasingly being recognized. The case-fatality rate in patients with solid tumors and BSI is high, especially among those with comorbidities, advanced neoplasms, corticosteroid therapy, and shock at presentation.

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Section: Etiology Of Bloodstream Infection In Patients With Solid Tumorsmentioning

confidence: 99%

Bloodstream infections in patients with solid tumors

2016

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“…FN is associated with increased morbidity and an in‐hospital mortality rate around 10% and is a major dose‐limiting event occurring during chemotherapy in patients with cancer . Risk factors for short‐term complications of FN (death, organ failure, or admission to the intensive care unit [ICU]) include age, cancer type, comorbidities, delayed antibiotics, and laboratory or vital sign abnormalities . Different combinations of these risk factors have been used to develop the Talcott, MASCC, and CISNE risk scores that have contributed widely to improve the management of FN.…”

Section: Introductionmentioning

confidence: 99%

Mortality and admission to intensive care units after febrile neutropenia in patients with cancer

et al. 2020

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Febrile neutropenia (FN) is a critical complication of chemotherapy associated with increased in-hospital mortality. However, associations with increased mortality and intensive care unit (ICU) admissions during longer follow-up are not established. Patients treated with standard first-line chemotherapy for solid cancers at Rigshospitalet, Denmark in 2010-2016 were included. Incidence rate ratios (IRR) of all-cause, infectious and cardiovascular mortality, and ICU admissions after FN were analyzed by Poisson regression. Risk factors at the time of FN were analyzed in the subpopulation of patients with FN; all-cause mortality was further stratified by the time periods 0-30, 31-365, and 366+ days after FN. We included 9018 patients with gastric (14.4%) and breast (13.1%) cancer being the most common, 51.2% had locally advanced or disseminated disease and the patients had a median Charlson Comorbidity Index score of 0 (interquartile range, 0-0). During follow-up, 845 (9.4%) experienced FN and 4483 (49.7%) died during 18 775 person-years of followup. After adjustment, FN was associated with increased risk of all-cause mortality,infectious mortality, and ICU admissions with IRRs of 1.39 (95% CI, 1.24-1.56), 1.94 (95% CI, 1.43-2.62), and 2.28 (95% CI, 1.60-3.24). Among those with FN, having a positive blood culture and low lymphocytes were associated with excess risk of death and ICU admissions (predominantly the first 30 days after FN), while elevated C-reactive protein and low hemoglobin predicted mortality the first year after FN.The risk of death varied according to the time since FN; adjusted IRR per additional risk factor present for the time periods 0-30, 31-365, and 366+ days after FN were 2.00 (95% CI, 1.45-2.75), 1.36 (95% CI, 1.17-1.57), and 1.17 (95% CI, 0.98-1.41). FN was associated with increased mortality and risk of ICU admissions. An objectively identifiable subgroup of patients among those with FN carried this excess risk. K E Y W O R D S cancer, febrile neutropenia, infection, mortality, prognosis 3034 | AAGAARD et Al.

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“…Moreover, management of FN has been reformed by risk scores. Risk scores, such as the Multinational Association of Supportive Care in Cancer and Clinical Index of Stable Febrile Neutropenia scores, can identify those patients presenting with FN who are at low risk and who can be treated as outpatients. Similarly, risk stratification of patients according to the risk of developing FN before chemotherapy delivery could further improve patient care.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a cycle‐specific risk score for febrile neutropenia during chemotherapy cycles 2–6 in patients with solid cancers: The ^CSRFENCE score

Aagaard

Reekie

Roen

et al. 2019

Intl Journal of Cancer

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The absolute risk reduction by prophylaxis in chemotherapy‐induced febrile neutropenia (FN) is largest in patients at highest underlying risk. Therefore, reliable predictive models are needed. Here, we develop and validate such a model for risk of FN during chemotherapy cycles 2–6. A prediction score for risk of FN during the first cycle has recently been published. Patients with solid cancers initiating first‐line chemotherapy in 2010–2016 were included. Cycle‐specific risk factors were assessed by Poisson regression using generalized estimating equations and random split sampling. The derivation cohort included 4,590 patients treated with 15,419 cycles, wherein 326 (2.1%) FN events occurred. Predictors of FN in multivariable analyses were: higher predicted risk of FN in the first cycle, platinum‐ or taxane‐containing therapies, concurrent radiotherapy, treatment in cycle 2 compared to later cycles, previous FN or neutropenia and not receiving granulocyte colony‐stimulating factors. Each predictor added between −2 and 8 points to each patient's score (median score 4; interquartile range, 1–6). The incidence rate ratios for developing FN in the intermediate (score 1–4), high (score 5–6) and very high risk groups (score ≥7) were 7.8 (95% CI, 2.4–24.9), 18.6 (95% CI, 5.9–58.8) and 51.7 (95% CI, 16.5–162.3) compared to the low risk group (score ≤0), respectively. The score had good discriminatory ability with a Harrell's C‐statistic of 0.78 (95% CI, 0.76–0.80) in the derivation and 0.75 (95% CI, 0.72–0.78) in the validation cohort (patient n = 2,295, cycle n = 7,670). The Cycle‐Specific Risk of FEbrile Neutropenia after ChEmotherapy score is the first published method to estimate cycle‐specific risk of FN.

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Prediction of Serious Complications in Patients With Seemingly Stable Febrile Neutropenia: Validation of the Clinical Index of Stable Febrile Neutropenia in a Prospective Cohort of Patients From the FINITE Study

Abstract: CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes.

Cited by 127 publications

References 23 publications

Bloodstream infections in patients with solid tumors

Bloodstream infections in patients with solid tumors

Mortality and admission to intensive care units after febrile neutropenia in patients with cancer

Development and validation of a cycle‐specific risk score for febrile neutropenia during chemotherapy cycles 2–6 in patients with solid cancers: The ^CSRFENCE score

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Prediction of Serious Complications in Patients With Seemingly Stable Febrile Neutropenia: Validation of the Clinical Index of Stable Febrile Neutropenia in a Prospective Cohort of Patients From the FINITE Study

Abstract: CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes.

Cited by 127 publications

References 23 publications

Bloodstream infections in patients with solid tumors

Bloodstream infections in patients with solid tumors

Mortality and admission to intensive care units after febrile neutropenia in patients with cancer

Development and validation of a cycle‐specific risk score for febrile neutropenia during chemotherapy cycles 2–6 in patients with solid cancers: The CSRFENCE score

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Development and validation of a cycle‐specific risk score for febrile neutropenia during chemotherapy cycles 2–6 in patients with solid cancers: The ^CSRFENCE score