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Predictive factors of bacteraemia in low-risk patients with febrile neutropenia
  1. Shin Ahn1,
  2. Yoon-Seon Lee1,
  3. Yeon Hee Chun1,
  4. Kyung Soo Lim1,
  5. Won Kim1,
  6. Jae-Lyun Lee2
  1. 1Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
  2. 2Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
  1. Correspondence to Professor Yoon-Seon Lee, Department of Emergency Medicine, Cancer Emergency, Asan Medical Center, University of Ulsan, College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea; ysdoc{at}amc.seoul.kr

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 ×103/mm3), 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.

  • Febrile neutropenia
  • bacteraemia
  • chemotherapy
  • cancer
  • clinical care
  • environmental medicine
  • infectious diseases
  • imaging
  • ultrasound
  • cardiac arrest

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Asan Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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