Predictive factors of bacteraemia in low-risk patients with febrile neutropenia. Issue 9 (19th October 2011)

• Record Type: Journal Article
• Authors: Ahn, Shin; Lee, Yoon-Seon; Chun, Yeon Hee; Lim, Kyung Soo; Kim, Won; Lee, Jae-Lyun
• Is Part Of: Emergency medicine journal. Volume 29:Issue 9(2012)
• Page Start: 715
• Page End: 719
• Publication Date: 2011-10-19
• Subjects: Febrile neutropenia -- bacteraemia -- chemotherapy -- cancer -- clinical care -- environmental medicine -- infectious diseases -- imaging -- ultrasound -- cardiac arrest; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2011-200012
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Purpose: The authors intended to determine the predictive factors of bacteraemia in low-risk febrile neutropenia (FN) classified by the Multinational Association for Supportive Care in Cancer Risk Index score. Methods: FN episodes managed in an emergency department from June 2009 to May 2010 were included. Clinical and laboratory features including procalcitonin (PCT) and C reactive protein (CRP) were retrospectively analysed. Results: Of the total 285 episodes, 243 (85.3%) were classified as low risk. In this group, 19 (7.8%) had bacteraemia. There was a significant difference (p<0.05) in age, respiration rate ≥24 (36.8% vs 7.6%), Eastern Cooperative Oncology Group performance status (PS) ≥2 (42.1% vs 11.6%), platelet counts (107.0±42.4 vs 131.8±73.7 ×10 3 /mm 3 ), serum aspartate aminotransferase (42.3±30.7 vs 28.7±17.4 IU/litre) and blood urea nitrogen (19.6±9.8 vs 11.6± 8.6 mg/dl) between episodes with and without bacteraemia. PCT ≥0.5 ng/ml and CRP ≥10 mg/dl had higher rates of bacteraemia than PCT <0.5 ng/ml (28.2% vs 3.9%, p<0.001) and CRP <10 mg/dl (13.9% vs 5.3%, p=0.022) did. On multivariate analysis, PCT ≥0.5 ng/ml (OR 4.7, 95% CI 1.38 to 16.29), respiration rate ≥24 (OR 4.1, 95% CI 1.20 to 13.63) and Eastern Cooperative Oncology Group PS ≥2 (OR 3.2, 95% CI 1.02 to 10.10) were predictive of bacteraemia in the low-risk group. Conclusion: PCT, tachypnoea and PS were predictive of bacteraemia in the low-risk patients with FN. If the patient has high probability of bacteraemia, the patient could benefit from parenteral antibiotic treatment while awaiting the blood culture results.