Risk assessment of patients with hematologic malignancies who develop fever accompanied by pulmonary infiltrates

Abstract

BACKGROUNDThe mortality rate associated with fever accompanied by pulmonary infiltrates after chemotherapy for hematologic malignancies remains higher than the corresponding rate associated with febrile neutropenia without pulmonary infiltrates. Nonetheless, few studies have focused on the factors that predict outcome for patients with lung infiltrates. The purpose of the current study was to construct a risk model for clinical use by assessing the factors that affect outcome for patients with fever and pulmonary infiltrates.METHODSA historical cohort of 110 patients with hematologic malignancies who developed fever and pulmonary infiltrates was examined. Using parameters for which data were available at the onset of lung infiltrates, univariate and multivariate analyses were performed to assess factors affecting outcome. After a value of one point was assigned to each significant variable, a prediction score was calculated for each patient; scores were used to generate a system for identifying patients with a low risk of death due to fever accompanied by pulmonary infiltrates.RESULTSThe crude mortality rate associated with pulmonary infiltrates was 23%; factors associated with cure included a favorable change in white blood cell counts (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.7–18.9; P = 0.001), C‐reactive protein levels < 10 mg/dL (OR, 4.6; 95% CI, 1.6–13.8; P = 0.001), and serum albumin levels ≥ 3 g/dL (OR, 3.2; 95% CI, 1.4–7.3; P = 0.004). Low‐risk patients (risk score, 2–3) and high‐risk patients (risk score, 0–1) had survival rates of 95% and 46%, respectively (P < 0.0001). The risk model had a specificity of 88% and a positive predictive value of 95%.CONCLUSIONSThe risk model tested in the current study accurately predicted the survival of patients with hematologic malignancies who developed fever with pulmonary infiltrates. Once prospectively validated, the model could be used to select patients for trials involving novel diagnostic and therapeutic strategies. Cancer 2004. © 2004 American Cancer Society.

Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial

“…Pneumonia remains a major challenge in acute leukemia treatment 5, 8, 9, 30 with a substantial mortality 27, 31. Prospective reports have demonstrated the feasibility and safety of outpatient management and early discharge of acute leukemia by inclusion of broad‐spectrum AP 11, 12, 17, 18, 20.…”

“…Pneumonia, defined as X‐ray‐verified pulmonary infiltrate in addition to fever 27, was the primary outcome based on guidelines from Statens Serum Institut, Copenhagen, Denmark (https://www.ssi.dk/) 28 and the British National Guideline Centre 29. Imaging investigations were performed at the included sites with radiologists blinded to study group allocation.…”

“…In contrast to risk stratification in community‐acquired pneumonia, no validated methods currently exist to risk score patients with hospital‐acquired pneumonias or healthcare associated pneumonia 27. Additionally, we did not separate or define pneumonias as either (HAP) or (CAP) due to the patients shifting statuses of being admitted or treated in the outpatient setting under prescription of AP during neutropenia 29.…”

Approach to Fever Assessment in Ambulatory Cancer Patients Receiving Chemotherapy: A Clinical Practice Guideline

“…Evidence from the review of the primary literature found six studies addressing the predictive value of body temperature. The patients who were involved had already been diagnosed with febrile neutropenia, and the cut-off used in five studies was 39°C [16][17][18][19][20] . In those studies, temperature was an unreliable predictor of poor outcome.…”

Diagnostic value of C-reactive protein in discriminating fungal from nonfungal pulmonary infiltrates in patients with hematologic malignancies

“…The aim of our recently published risk model was to predict the outcome of hematologic patients with fever and pulmonary infiltrates. We found that CRP, serum albumin level, and trend in white blood cell (WBC) count were predictive of pulmonary infiltrate outcome [7]. However, it is also substantial to recognize factors predicting the etiology of pulmonary infiltrates.…”