Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia

Abstract

MASCC risk-index score <21, tachypnea, thrombocytopenia, increased CRP, and prolonged neutropenia may be strongly associated with poor outcomes in cancer patients with FN.

Predictive factors of bacteraemia in low-risk patients with febrile neutropenia

“…This result was comparable to the other studies, and the risk of bacteraemia and its complications can be still substantial even in the low-risk group 8 9 12. Although bacteraemia was not categorised as one of the serious medical complications in the MASCC scoring system, it is known to be related to poor outcomes of FN in high- and low-risk patients,13 14 and the decision for outpatient treatment with oral antibiotics could be problematic to emergency physicians in the era of high antibiotics resistance.…”

“…Among the systemic inflammatory response syndrome criteria, tachypnoea was the only factor that significantly predicted shock development in patients with fewer by multivariate analysis 22. Similarly, in a recent study regarding hospitalised patients with haematologic malignancies, tachypnoea was the most significant predictor of septic shock,23 and also in our previous report, tachypnoea was one of the predictive factors for poor prognosis in patients with cancer with chemotherapy-induced FN 8…”

“…Based on this classification, it was suggested that the low-risk patients could be eligible for early discharge for outpatient treatment, rather than routine inpatient admission. However, even in the low-risk MASCC group, the risk of bacteraemia and complications can be still substantial 8 9…”

Impact of time to antibiotics on outcomes of chemotherapy-induced febrile neutropenia

“…Timing cutoffs for antibiotics included the following: ≤1 vs. >1, ≤2 vs. >2, ≤3 vs. >3, and ≤4 vs. >4 h. With each cutoff, multivariable logistic regression analyses were separately performed to adjust for potential confounding in the association between timing intervals and episode outcomes. We considered the MASCC risk-index score, serum Creactive protein and procalcitonin levels, Eastern Cooperative Oncology Group (ECOG) performance score, and days passed since the last chemotherapy as potential confounders [13][14][15]. These potential confounding factors were determined a priori, forced into the final model along with the antibiotic timing at each timing cutoff, and adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) for the outcomes were presented.…”

The Diagnostic Approach to the Febrile Neutropenic Patient: Clinical Considerations

“…The French ELYPSE study group characterised regimens at high risk for neutropenic fevers as those containing anthracyclines (doxorubicin or epirubicin) ≥90 mg/m 2 , cisplatin ≥100 mg/m 2 , ifosfamide ≥9 g/ m 2 , cyclophosphamide ≥1 g/m 2 , etoposide ≥500 mg/m 2 , or cytarabine ≥100 mg/ m 2 per course [ 84 ]. Choice of chemotherapeutic regimen is a key driver of cytotoxic therapy-induced complications including grade 4 neutropenia, onset of neutropenic fever syndromes, and reductions in relative dose intensity and consequent impact upon survival.…”