Morbidity and mortality in patients with febrile neutropenia from the Hospital Nacional, 2017-2019
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Abstract
Introduction: neutropenia is a situation with risk of infections that can generate high morbidity and mortality. Fever is a risk factor for complications.
Objective: to determine the relation of fever with morbidity and mortality, and length of hospitalization in patients with neutropenia.
Methodology: observational, retrospective design, carried out on adult patients with neutropenia hospitalized at the Hospital Nacional (Itauguá, Paraguay) between 2017 and 2019. Two cohorts were formed: one with neutropenic patients with fever and the other without fever. The independent variable was fever and the dependent variables were morbidity and mortality, hospitalization days, and nosocomial complications. All patients were treated with current protocols. The study had the approval of the Comité de Ética of the Universidad Nacional de Itapúa.
Results: 169 subjects with neutropenia entered the study, with a mean age of 44 ± 20 years, being 51,4 % female. The fever cohort was made up of 76 subjects, with a mean hospitalization of 20 ± 10 days and mortality of 30,9 %. The fever-free cohort was made up of 96 subjects, had a mean hospitalization of 15 ± 10 days and mortality of 10,7 %.
Conclusions: fever in patients with neutropenia is associated with higher mortality, nosocomial complications and hospital stay.
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References
Dasgupta S, Mandal P, Chakrabarti S. Etiology of pancytopenia: an observation from a referral medical institution of Eastern Region of India. J Lab Physicians. 2015;7(2):90-5. doi: 10.4103/0974-2727.163136.
Das Makheja K, Kumar Maheshwari B, Arain S, Kumar S, Kumari S, Vikash. The common causes leading to pancytopenia in patients presenting to tertiary care hospital. Pak J Med Sci. 2013;29(5):1108–11. doi: 10.12669/pjms.295.3458
Gayathri BN, Rao KS. Pancytopenia: a clinic hematological study. J Lab Physicians. 2011;3(1):15-20. doi: 10.4103/0974-2727.78555.
Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, et al. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol. 2016;172(2):187–207. doi: 10.1111/bjh.13853.
Jain A, Naniwadekar M. An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital. BMC Hematol. 2013;13(1):10. doi: 10.1186/2052-1839-13-10.
White L, Ybarra M. Neutropenic Fever. Hematol Oncol Clin North Am. 2017;31(6):981–93. doi: 10.1016/j.hoc.2017.08.004
Carmona Bayonas A, Herrero Martínez JA, Martínez García J, Marín Vera M, De Las Heras González M, Navarrete Montoya A. Neutropenia febril: Análisis de los factores pronósticos y el tratamiento adaptado al riesgo. Revisión crítica. Oncol. (Barc.) 2006;29(5):34-46.
Bellesso M, Costa SF, Chamone DAF, Llacer PED. Screening for the outpatient treatment of febrile neutropenia. Rev Bras Hematol Hemoter. 2010;32(5):402–8. doi: 10.1590/S1516-84842010000500014.
Heinz WJ, Buchheidt D, Christopeit M, von Lilienfeld-Toal M, Cornely OA, Einsele H, et al. Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2017;96(11):1775–1792. doi: 10.1007/s00277-017-3098-3.
Rabagliati BR, Fuentes LG, Orellana UE, Oporto CJ, Domínguez MI, Benítez GR, et al. Etiología de episodios de neutropenia febril en pacientes adultos con cáncer hematológico y de órganos sólidos en el Hospital Clínico Universidad Católica, Santiago-Chile. Rev Chilena Infectol. 2009;26(2):106–13. doi: /S0716-10182009000200001.
Garzón JR, Cuervo MS, Gómez RJ, Cortés JA. Farmacocinética y farmacodinamia de antimicrobianos: A propósito de pacientes con neutropenia y fiebre. Rev Chilena Infectol. 2011;28(6):537–45. doi: /S0716-10182011000700005.
Madrid C, Díaz L, Combariza J, Gálvez K, Olaya V, Ramírez I, et al. Epidemiology of febrile neutropenia in adult patients with hematologic neoplasms in a period of 26 months in Hospital Pablo Tobón Uribe, Colombia. Rev Chilena Infectol. 2013;30(2):195–201.
Puentes GA, Quiroga C, Álvarez CA, Támara JR, Ruiz Á. Demographics, morbidity, and mortality febrile neutropenic adult patients treated with cefepime. Rev Chil Infectol. 2012;29(3):322–8. doi: 10.4067/S0716-10182013000200010.
Cuervo Maldonado SI, Bermúdez CD, Enciso L, Gómez Rincón JC, Castillo JS, Sánchez R, et al. Guía de práctica clínica para el diagnóstico y el tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo. Rev Colomb Cancerol. 2014;18(4):186–96. doi: 10.1016/j.rccan.2014.06.002
Ramos Martínez A, Pintos Pascual I, Múñez Rubio E. Protocolo diagnóstico y tratamiento de la neutropenia febril. Medicine (Madr). 2018;12(55):3272–3276. doi: 10.1016/j.med.2018.04.014
Taj M, Nadeem M, Maqsood S, Shah T, Farzana T, Shamsi TS.Validation of MASCC Score for Risk Stratification in Patients of Hematological Disorders with Febrile Neutropenia. Indian J Hematol Blood Transfus. 2017;33(3):355-360. doi: 10.1007/s12288-016-0730-7.
Moon H, Choi YJ, Sim SH. Validation of the Clinical Index of Stable Febrile Neutropenia (CISNE) model in febrile neutropenia patients visiting the emergency department. Can it guide emergency physicians to a reasonable decision on outpatient vs. inpatient treatment? PLoS One. 2018;13(12):e0210019. doi: 10.1371/journal.pone.0210019. eCollection 2018.
González Mercado NR. Características clínicas y microbiológicas asociadas a la neutropenia febril. Rev. virtual Soc. Parag. Med. Int. 2017;4(2):34-41. doi: 10.18004/rvspmi/2312-3893/2017.04(02)34-041.
Parodi RL, Lagrutta M, Tortolo M, Navall E, Rodríguez MS, Sasia GF, De Candia LF, Gruvman MA, Bottasso O, Greca AA. A multicenter prospective study of 515 febrile neutropenia episodes in Argentina during a 5-year period. PLoS One. 2019;14(10):e0224299. doi: 10.1371/journal.pone.0224299. eCollection 2019.
Hansen BA, Wendelbo Ø, Bruserud Ø, Hemsing AL, Mosevoll KA, Reikvam H. Febrile neutropenia in acute leukemia. Epidemiology, etiology, pathophysiology and treatment. Mediterr J Hematol Infect Dis. 2020;12(1):e2020009. doi: 10.4084/MJHID.2020.009. eCollection 2020.
Carmona Bayonas A, Jimenez Fonseca P, de Castro EM, Mata E, Biosca M, Custodio A, Espinosa J, et al. SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018). Clin Transl Oncol. 2019;21(1):75-86. doi: 10.1007/s12094-018-1983-4.
Carmona Bayonas A, Jiménez Fonseca P, Virizuela J, Antonio M, Font C, Biosca M, et al. Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors. Clin Transl Oncol. 2017;19(3):386-395. doi: 10.1007/s12094-016-1540-y.
Calik S, Ari A, Bilgir O, Cetintepe T, Yis R, Sonmez U, et al.The relationship between mortality and microbiological parameters in febrile neutropenic patients with hematological malignancies. Saudi Med J. 2018;39(9):878-885. doi: 10.15537/smj.2018.9.22824.
Chindaprasirt J, Wanitpongpun C, Limpawattana P, Thepsuthammarat K, Sripakdee W, Sookprasert A, et al. Mortality, length of stay, and cost associated with hospitalized adult cancer patients with febrile neutropenia. Asian Pac J Cancer Prev. 2013;14(2):1115-9. doi: 10.7314/apjcp.2013.14.2.1115.
Vahedian-Ardakani HA, Moghimi M, Shayestehpour M, Doosti M, Amid N.Bacterial Spectrum and Antimicrobial Resistance Pattern in Cancer Patients with Febrile Neutropenia. Asian Pac J Cancer Prev. 2019;20(5):1471-1474.
Al-Tawfiq JA, Hinedi K, Khairallah H, Saadeh B, Abbasi S, Noureen M, et al. Epidemiology and source of infection in patients with febrile neutropenia: A ten-year longitudinal study. J Infect Public Health. 2019;12(3):364-366. doi: 10.1016/j.jiph.2018.12.006.
Limvorapitak W, Khawcharoenporn T. Incidence, Risk Factors, and Outcomes of Febrile Neutropenia in Thai Hematologic Malignancy Patients Receiving Chemotherapy: A 6-year Retrospective Cohort Study. Asian Pac J Cancer Prev. 2015;16(14):5945-50. doi: 10.7314/apjcp.2015.16.14.5945.
Kawatkar AA, Farias AJ, Chao C, Chen W, Barron R, Vogl FD, et al. Hospitalizations, outcomes, and management costs of febrile neutropenia in patients from a managed care population. Support Care Cancer. 2017;25(9):2787-2795. doi: 10.1007/s00520-017-3692-x.
Roy Torales TE, Peralta Giménez R, González Aquino LA, Backer W, Dias CI, llatas Zapata HR, et al. Índice de comorbilidad de Charlson aplicado a pacientes de Medicina Interna: estudio multicéntrico. Rev. virtual Soc. Parag. Med. Int. 2019;6(2):47-56. doi: 10.18004/rvspmi/2312-3893/2019.06.02.47-056.
Baugh CW, Faridi MK, Mueller EL, Camargo CA Jr, Pallin DJ. Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia. PLoS One. 2019;14(5):e0216835. doi: 10.1371/journal.pone.0216835. eCollection 2019.
Rivas Ruiz R, Villasis Keever M, Miranda Novales G, Castelán Martínez OD, Rivas Contreras S. Outpatient treatment for people with cancer who develop a low-risk febrile neutropaenic event. Cochrane Database Syst Rev. 2019;3:CD009031. doi: 10.1002/14651858.CD009031.pub2.
Baig H, Somlo B, Eisen M, Stryker S, Bensink M, Morrow PK. Appropriateness of granulocyte colony-stimulating factor use in patients receiving chemotherapy by febrile neutropenia risk level. J Oncol Pharm Pract. 2019;25(7):1576-1585. doi: 10.1177/1078155218799859.
Ferreira JN, Correia LRBR, Oliveira RM, Watanabe SN, Possari JF, Lima AFC. Managing febrile neutropenia in adult cancer patients: an integrative review of the literature. Rev. Bras. Enferm. 2017;70(6):1301-8. doi: 10.1590/0034-7167-2016-0247.
Lyman GH, Dale DC, Legg JC, Abella E, Morrow PK, Whittaker S, et al. Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk? Cancer Med. 2015;4(8):1153-60. doi: 10.1002/cam4.454.
Rosa RG, Goldani LZ. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother. 2014;58(7):3799-803. doi: 10.1128/AAC.02561-14.
Shilpakar R, Paudel BD, Neupane P, Shah A, Acharya B, Dulal S, et al. Procalcitonin and C-Reactive protein as markers of bacteremia in patients with febrile neutropenia who receive chemotherapy for acute leukemia: a prospective study from Nepal. J Glob Oncol. 2019;5:1-6. doi: 10.1200/JGO.19.00147.
Pérez López E, Redondo Guijo A. Protocolo de manejo clínico de la neutropenia asintomática y febril. Medicine (Madr). 2016;12(21):1235–1240. doi: 10.1016/j.med.2016.10.014