Factors Associated with Survival Outcomes of Febrile Neutropenia in Hematologic Malignancy Patients

Abstract

Background: Febrile neutropenia (FN) is a common, life-threatening complication of hematologic malignancy patients who receive chemotherapy. The assessment of the epidemiology and related factors are necessary to improve survival outcomes of FN.

Objective: To determine the epidemiology of FN and investigate the factors that are associated with outcomes of FN.

Material and method: This study is a retrospective cohort study. Medical records between 2012 and 2014 of fifty FN patients of the Her Royal Highness (HRH) Princess Maha Chakri Sirindhorn Medical Center were reviewed.

Results: Of the 50 episodes with FN, the median age was 35.5 years (range from 15 to 81 years), and 39 patients (78%) were younger than 60 years of age. Thirty-three patients (66%) were treated with the first-line chemotherapy. Source of infections could not be identified in 58% of patients. For patients with a definite source of infection, 14% were lower respiratory tract infections. Gram-negative bacteria were more common than gram-positive organisms as found in blood cultures. The multivariate analysis has confirmed a significant association with no weight loss greater than 5% within 1 month (p<0.05), no blood loss requiring intravenous fluid (p = 0.01), and low Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = 0.01) associated with survival outcomes of FN. The overall mortality was 28%.

Conclusion: There was a high mortality rate in neutropenic patients with fever. The no significant weight loss, no blood loss requiring intravenous fluid, and low APACHE II score at the time of diagnosed FN were found to be associated factors with survival outcomes.