PREDICTORS OF OUTCOME AND SEVERITY IN ADULT FILIPINO PATIENTS WITH FEBRILE NEUTROPENIA
(Abstract release date: 05/21/15)
EHA Library. Villalobos R. 06/12/15; 102570; PB1815
Disclosure(s): Philippine General HospitalDepartment of Internal Medicine
Ralph Elvi Villalobos
Contributions
Contributions
Abstract
Abstract: PB1815
Type: Publication Only
Background
Febrile neutropenia carries a significant mortality rate of 5-21.5%, warranting early recognition and institution of appropriate therapy. In the Philippines, there is a lack of studies on prognostic factors that predict poor outcome in patients with febrile neutropenia. It is important to identify these factors to recognize patients who will benefit from early aggressive therapy and closer monitoring.
Aims
The study aimed to describe the clinical, laboratory, and microbiologic profile of adult Filipino patients with febrile neutropenia, and to determine specific parameters that are potentially associated with severe outcomes, complications, and mortality.
Methods
This is a retrospective study of adult febrile neutropenia patients, regardless of cause, admitted at the Philippine General Hospital from January 2010-October 2014. Patients were described in terms of clinical, laboratory, and microbiologic presentation, and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using univariate and multivariate logistic regression analysis.
Results
A total of 115 febrile episodes in 102 patients were identified. There was no difference in median age or gender ratio between the complicated and non-complicated groups; leukemia (48.7%) was the most common primary underlying disease in both groups. Most patients (50.43%) had infections of the respiratory tract, with Gram negative organisms predominating in the complicated group. The factors that significantly predicted poor outcome in the univariate analysis were non-treatment/relapse of the underlying disease (OR 2.28; 95% CI, 1.04-4.98; p=0.040), prolonged fever >7 days prior to admission (OR 3.24; 95% CI, 1.16-9.01; p=0.024), non-recovery from neutropenia (OR 2.17; 95% CI, 1.01-4.68; p=0.048), and severe thrombocytopenia <50,000/uL (OR 3.45; 95% CI, 1.52-7.84; p=0.003.) Meanwhile, completeness of antibiotic therapy significantly predicted a better outcome (OR 0.26; 95% CI 0.12-0.57; p=0.001.) Using the factors that reached significance in the univariate analysis, subsequent multivariate analysis yielded prolonged fever (OR 2.43; 95% CI, 0.77-7.74), isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04-6.98), and nadir absolute neutrophil count (ANC) <100 during admission (OR 1.96; 95% CI, 0.75-5.12) as significant predictors of poor outcome. The factors that significantly correlated with better outcome were granulocyte colony-stimulating factor (G-CSF) use (OR 0.31; 95% CI, 0.11-0.85) and completeness of antibiotic therapy (OR 0.26; 95% CI, 0.10-
Summary
Adult febrile neutropenia patients with prolonged fever >7 days prior to admission, known pathogen on cultures, and nadir ANC <100 during admission were at significant risk of developing worse outcomes, whereas those with G-CSF use and complete antibiotic therapy were significantly associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and closer monitoring.
Keyword(s): Neutropenia, Sepsis
Type: Publication Only
Background
Febrile neutropenia carries a significant mortality rate of 5-21.5%, warranting early recognition and institution of appropriate therapy. In the Philippines, there is a lack of studies on prognostic factors that predict poor outcome in patients with febrile neutropenia. It is important to identify these factors to recognize patients who will benefit from early aggressive therapy and closer monitoring.
Aims
The study aimed to describe the clinical, laboratory, and microbiologic profile of adult Filipino patients with febrile neutropenia, and to determine specific parameters that are potentially associated with severe outcomes, complications, and mortality.
Methods
This is a retrospective study of adult febrile neutropenia patients, regardless of cause, admitted at the Philippine General Hospital from January 2010-October 2014. Patients were described in terms of clinical, laboratory, and microbiologic presentation, and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using univariate and multivariate logistic regression analysis.
Results
A total of 115 febrile episodes in 102 patients were identified. There was no difference in median age or gender ratio between the complicated and non-complicated groups; leukemia (48.7%) was the most common primary underlying disease in both groups. Most patients (50.43%) had infections of the respiratory tract, with Gram negative organisms predominating in the complicated group. The factors that significantly predicted poor outcome in the univariate analysis were non-treatment/relapse of the underlying disease (OR 2.28; 95% CI, 1.04-4.98; p=0.040), prolonged fever >7 days prior to admission (OR 3.24; 95% CI, 1.16-9.01; p=0.024), non-recovery from neutropenia (OR 2.17; 95% CI, 1.01-4.68; p=0.048), and severe thrombocytopenia <50,000/uL (OR 3.45; 95% CI, 1.52-7.84; p=0.003.) Meanwhile, completeness of antibiotic therapy significantly predicted a better outcome (OR 0.26; 95% CI 0.12-0.57; p=0.001.) Using the factors that reached significance in the univariate analysis, subsequent multivariate analysis yielded prolonged fever (OR 2.43; 95% CI, 0.77-7.74), isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04-6.98), and nadir absolute neutrophil count (ANC) <100 during admission (OR 1.96; 95% CI, 0.75-5.12) as significant predictors of poor outcome. The factors that significantly correlated with better outcome were granulocyte colony-stimulating factor (G-CSF) use (OR 0.31; 95% CI, 0.11-0.85) and completeness of antibiotic therapy (OR 0.26; 95% CI, 0.10-
Summary
Adult febrile neutropenia patients with prolonged fever >7 days prior to admission, known pathogen on cultures, and nadir ANC <100 during admission were at significant risk of developing worse outcomes, whereas those with G-CSF use and complete antibiotic therapy were significantly associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and closer monitoring.
Keyword(s): Neutropenia, Sepsis
Abstract: PB1815
Type: Publication Only
Background
Febrile neutropenia carries a significant mortality rate of 5-21.5%, warranting early recognition and institution of appropriate therapy. In the Philippines, there is a lack of studies on prognostic factors that predict poor outcome in patients with febrile neutropenia. It is important to identify these factors to recognize patients who will benefit from early aggressive therapy and closer monitoring.
Aims
The study aimed to describe the clinical, laboratory, and microbiologic profile of adult Filipino patients with febrile neutropenia, and to determine specific parameters that are potentially associated with severe outcomes, complications, and mortality.
Methods
This is a retrospective study of adult febrile neutropenia patients, regardless of cause, admitted at the Philippine General Hospital from January 2010-October 2014. Patients were described in terms of clinical, laboratory, and microbiologic presentation, and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using univariate and multivariate logistic regression analysis.
Results
A total of 115 febrile episodes in 102 patients were identified. There was no difference in median age or gender ratio between the complicated and non-complicated groups; leukemia (48.7%) was the most common primary underlying disease in both groups. Most patients (50.43%) had infections of the respiratory tract, with Gram negative organisms predominating in the complicated group. The factors that significantly predicted poor outcome in the univariate analysis were non-treatment/relapse of the underlying disease (OR 2.28; 95% CI, 1.04-4.98; p=0.040), prolonged fever >7 days prior to admission (OR 3.24; 95% CI, 1.16-9.01; p=0.024), non-recovery from neutropenia (OR 2.17; 95% CI, 1.01-4.68; p=0.048), and severe thrombocytopenia <50,000/uL (OR 3.45; 95% CI, 1.52-7.84; p=0.003.) Meanwhile, completeness of antibiotic therapy significantly predicted a better outcome (OR 0.26; 95% CI 0.12-0.57; p=0.001.) Using the factors that reached significance in the univariate analysis, subsequent multivariate analysis yielded prolonged fever (OR 2.43; 95% CI, 0.77-7.74), isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04-6.98), and nadir absolute neutrophil count (ANC) <100 during admission (OR 1.96; 95% CI, 0.75-5.12) as significant predictors of poor outcome. The factors that significantly correlated with better outcome were granulocyte colony-stimulating factor (G-CSF) use (OR 0.31; 95% CI, 0.11-0.85) and completeness of antibiotic therapy (OR 0.26; 95% CI, 0.10-
Summary
Adult febrile neutropenia patients with prolonged fever >7 days prior to admission, known pathogen on cultures, and nadir ANC <100 during admission were at significant risk of developing worse outcomes, whereas those with G-CSF use and complete antibiotic therapy were significantly associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and closer monitoring.
Keyword(s): Neutropenia, Sepsis
Type: Publication Only
Background
Febrile neutropenia carries a significant mortality rate of 5-21.5%, warranting early recognition and institution of appropriate therapy. In the Philippines, there is a lack of studies on prognostic factors that predict poor outcome in patients with febrile neutropenia. It is important to identify these factors to recognize patients who will benefit from early aggressive therapy and closer monitoring.
Aims
The study aimed to describe the clinical, laboratory, and microbiologic profile of adult Filipino patients with febrile neutropenia, and to determine specific parameters that are potentially associated with severe outcomes, complications, and mortality.
Methods
This is a retrospective study of adult febrile neutropenia patients, regardless of cause, admitted at the Philippine General Hospital from January 2010-October 2014. Patients were described in terms of clinical, laboratory, and microbiologic presentation, and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using univariate and multivariate logistic regression analysis.
Results
A total of 115 febrile episodes in 102 patients were identified. There was no difference in median age or gender ratio between the complicated and non-complicated groups; leukemia (48.7%) was the most common primary underlying disease in both groups. Most patients (50.43%) had infections of the respiratory tract, with Gram negative organisms predominating in the complicated group. The factors that significantly predicted poor outcome in the univariate analysis were non-treatment/relapse of the underlying disease (OR 2.28; 95% CI, 1.04-4.98; p=0.040), prolonged fever >7 days prior to admission (OR 3.24; 95% CI, 1.16-9.01; p=0.024), non-recovery from neutropenia (OR 2.17; 95% CI, 1.01-4.68; p=0.048), and severe thrombocytopenia <50,000/uL (OR 3.45; 95% CI, 1.52-7.84; p=0.003.) Meanwhile, completeness of antibiotic therapy significantly predicted a better outcome (OR 0.26; 95% CI 0.12-0.57; p=0.001.) Using the factors that reached significance in the univariate analysis, subsequent multivariate analysis yielded prolonged fever (OR 2.43; 95% CI, 0.77-7.74), isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04-6.98), and nadir absolute neutrophil count (ANC) <100 during admission (OR 1.96; 95% CI, 0.75-5.12) as significant predictors of poor outcome. The factors that significantly correlated with better outcome were granulocyte colony-stimulating factor (G-CSF) use (OR 0.31; 95% CI, 0.11-0.85) and completeness of antibiotic therapy (OR 0.26; 95% CI, 0.10-
Summary
Adult febrile neutropenia patients with prolonged fever >7 days prior to admission, known pathogen on cultures, and nadir ANC <100 during admission were at significant risk of developing worse outcomes, whereas those with G-CSF use and complete antibiotic therapy were significantly associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and closer monitoring.
Keyword(s): Neutropenia, Sepsis
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