Outcome of severe infections in afebrile neutropenic cancer patients
, , et | 10 févr. 2016
À propos de cet article
Article Category: Research Article
Publié en ligne: 10 févr. 2016
Pages: 442 - 448
Reçu: 28 oct. 2015
Accepté: 05 nov. 2015
DOI: https://doi.org/10.1515/raon-2016-0011
© 2016 Radiol Oncol
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Prognostic factors associated with 30-day in-hospital mortality
| Prognostic factors | Died (n = 38) | Survived (n = 31) | p-value | |
|---|---|---|---|---|
| Age (years) | >65 | 17 | 11 | 0.44 |
| ≤ 65 | 21 | 20 | ||
| Cancer type | Lymphoma | 29 | 23 | 0.84 |
| Solid tumors | 9 | 8 | ||
| CCI | Low (0) | 17 | 11 | 0.44 |
| Medium - very high | 21 | 20 | ||
| (≥1) | ||||
| ACE-27 | None - mild (G0-1) | 20 | 13 | 0.38 |
| Moderate - severe | 18 | 18 | ||
| (G2-3) | ||||
| G-CSF prophylactic | Yes | 14 | 7 | 0.2 |
| No | 24 | 24 | ||
| G-CSF therapeutic | Yes | 12 | 7 | 0.41 |
| No | 26 | 24 | ||
| Fever status | Febrile | 31 | 29 | 0.17 |
| Afebrile | 7 | 2 | ||
| MASCC score | < 15 | 25 | 10 | 0.006 |
| ≥ 15 | 13 | 21 | ||
| Bloodstream infection | Yes | 15 | 10 | 0.54 |
| No | 23 | 21 | ||
| Mechanical ventilation | Yes | 26 | 4 | P < 0.001 |
| No | 12 | 27 | ||
| Lactic acidosisa | Yes | 7 | 0 | 0.04 |
| No | 31 | 27 | ||
| Time period of ICU admission (year) | 2000–2003 | 4 | 4 | 1.0 |
| 2004–2011 | 34 | 27 |
Baseline patients’ characteristics, cancer type and treatment
| Characteristics | N (%) (n = 69) | |
|---|---|---|
| Median age (range) | Elderly (> 65 years) | 58 years (31–86) 28 (40.6%) |
| Sex | Male | 42 (60.9%) |
| Female | 27 (39.1%) | |
| Cancer type | Lymphoma | 52 (75.4%) |
| Solid tumors | 17 (24.6%) | |
| Chemotherapy treatment intent | Neo/adjuvant solid or 1st-line lymphoma | 35 (50.7%) |
| 1st-line solid or 1st-relaps lymphoma | 13 (18.8%) | |
| 2nd-line solid or 2nd-relaps lymphoma | 12 (17.4%) | |
| ≥ 3rd-line solid or ≥ 3rd-relaps lymphoma | 9 (13.1%) | |
| CCI | Low (0) | 28 (40.6%) |
| Medium (1–2) | 30 (43.5%) | |
| High (3–4) | 8 (11.6%) | |
| Very high (≥ 5) | 3 (4.3%) | |
| ACE-27 | None (G0) | 17 (24.6%) |
| Mild (G1) | 16 (23.2%) | |
| Moderate (G2) | 13 (18.9%) | |
| Severe (G3) | 23(33.3%) | |
| WHO performance status | 0–2 | 54 (78.3%) |
| 3–4 | 15 (21.7%) | |
| Bone marrow infiltration | Yes | 22 (31.9%) |
| No | 29 (42.0 %) | |
| Unknown | 18 (26.1%) | |
| Previous neutropenic infection | Yes | 24 (34.8%) |
| No | 45 (65.2%) | |
| Site of infection Includes 53 episodes of microbiologically documented infection (MDI) and 16 episodes of clinically documented infection (CDI) | Bloodstream | 25 (36.2%) |
| Lower respiratory tract Pneumonias with 13 cases of MDI and 12 cases of CDI with radiological signs only | 25 (36.2%) | |
| Gastrointestinal tract Includes cases of cholecystitis, peritonitis, neutropenic enterocolitis | 13 (18.8%) | |
| Upper respiratory tract | 2 (2.9%) | |
| Urinary tract | 1 (1.5%) | |
| Skin and soft tissue | 1 (1.5%) | |
| Unexplained fever CDI with fever and signs of septic shock | 2 (2.9%) | |
| Time period of ICU admission (year) | 2000–2003 | 8 (13.6%) |
| 2004–2011 | 51 (86.4%) |
Comparison between patients with afebrile and febrile neutropenic infection
| Characteristics | Afebrile (n = 9) | Febrile (n = 60) | p-value | |
|---|---|---|---|---|
| Age (years) | < 65 | 4 | 24 | 1.0 |
| ≤ 65 | 5 | 36 | ||
| Sex | Male | 4 | 38 | 0.28 |
| Female | 5 | 22 | ||
| Cancer type | Lymphoma | 3 | 49 | 0.005 |
| Solid tumors | 6 | 11 | ||
| CCI | Low (0) | 5 | 23 | 0.47 |
| Medium - very high (≥ 1) | 4 | 37 | ||
| ACE-27 | None - mild (G0–1) | 5 | 28 | 0.73 |
| Moderate - severe (G2–3) | 4 | 32 | ||
| Status at diagnosis | Inpatient | 3 | 34 | 0.29 |
| Outpatient | 6 | 26 | ||
| MASCC score | < 15 | 5 | 30 | 1.0 |
| ≥ 15 | 4 | 30 | ||
| Severe neutropenia | Yes | 3 | 27 | 0.72 |
| No | 6 | 33 | ||
| Type of infection | MDI | 8 | 45 | 0.33 |
| CDI | 1 | 15 | ||
| Bloodstream infection n = 25 | Gram negative also includes polymicrobial bacteremias with at least one Gram negative bacteria | 4 | 16 | 0.55 |
| non-Gram negative | 0 | 5 | ||
| Mean time to the ICU (hours) | 41 | 54 | 0.73 |