In the management of febrile neutropenia; evaluation of the factors affecting the lenght of hospital stay

Year 2023, Volume: 14 Issue: 3, 587 - 591, 30.09.2023

Fatma Yılmaz , Buğra Sağlam , Merih Reis Aras , Hacer Berna Afacan Öztürk , Hafize Hilal Çayköylü , Aylin Merve Yapıcı Gülçiçek , Ahmet Kürşad Güneş , Murat Albayrak

https://doi.org/10.18663/tjcl.1342134

Abstract

Aim: Febrile neutropenia (FEN) is one of the most serious and commonly seen complications of patients receiving chemotherapy for a diagnosis of hematological malignancy. FEN is an emergency condition with mortality rates reaching 40% because of an increase in antimicrobial-resistant pathogens in particular. In a situation with such high mortality rates, parameters that can predict prognosis play an important role in the approach to the patient. The aim of this study was to investigate the parameters that could affect prognosis in the follow-up of FEN.
Material and Methods: The study included 58 patients hospitalised in the Hematology Clinic with a diagnosis of FEN. The patients were evaluated in respect of the recorded demographic characteristics, blood group, MASCC score, hemogram, procalcitonin, C-reactive protein (CRP), Interleukin-6 (IL-6), D-dimer, fibrinogen, pre-albumin, albumin, HbA1c, anthropometric measurements and length of stay in hospital.
Results: According to the statistical analysis results, patients with a length of hospital stay of ≥14 days were determined to have a significant decrease in the MASCC score and thrombocyte count and the procalcitonin, Il-6, D-dimer values and the number of antibiotics used were higher. No significant difference was determined between the groups in respect of the other parameters.
Conclusion: In the management of febrile neutropenia, the most important points are the establishment of indications for hospitalisation, rapid and early recognition of a worsening status and intervention made in the right place at the right time. Parameters with prognostic benefit will help the clinician in decision-making.

Keywords

febrile neutropenia, hematological malignancy, length of hospital stay, IL-6, procalcitonin

References

• Villafuerte-Gutierrez P, Villalon L, Losa JE, Henriquez-Camacho C. Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update. Advances in hematology. 2014;2014.
• Keck JM, Wingler MJB, Cretella DA, Vijayvargiya P, Wagner JL, Barber KE, et al. Approach to fever in patients with neutropenia: a review of diagnosis and management. Therapeutic Advances in Infectious Disease. 2022;9:20499361221138346.
• Klastersky J, De Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febrile neutropaenia: ESMO clinical practice guidelines. Annals of Oncology. 2016;27:v111-v8.
• Bodey GP, Buckley M, Sathe Y, FREIREICH EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Annals of internal medicine. 1966;64(2):328-40.
• Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106(10):2258-66.
• Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, et al. The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. Journal of clinical oncology. 2000;18(16):3038-51.
• Taj M, Nadeem M, Maqsood S, Shah T, Farzana T, Shamsi T. Validation of MASCC score for risk stratification in patients of hematological disorders with febrile neutropenia. Indian Journal of Hematology and Blood Transfusion. 2017;33:355-60.
• Baskaran ND, Gan GG, Adeeba K. Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Annals of hematology. 2008;87:563-9.
• Sezgi C, Taylan M, Kaya H, Selimoglu Sen H, Abakay O, Demir M, et al. Alterations in platelet count and mean platelet volume as predictors of patient outcome in the respiratory intensive care unit. The clinical respiratory journal. 2015;9(4):403-8.
• Yap CY, Aw TC. The use of procalcitonin in clinical practice. Proceedings of Singapore Healthcare. 2014;23(1):33-7.
• Qu J, Lü X, Liu Y, Wang X. Evaluation of procalcitonin, C-reactive protein, interleukin-6 & serum amyloid A as diagnostic biomarkers of bacterial infection in febrile patients. The Indian journal of medical research. 2015;141(3):315.
• Qu Z, Fang B, Ma G, Jiang J, Wang X, Wang J, et al. Significance of procalcitonin in bacterial infections among acute leukemia patients with post-chemotherapy agranulocytosis. Srpski arhiv za celokupno lekarstvo. 2017;145(7-8):382-6.
• Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, Parra-Virto A, Toledano-Macías M, Toledo-Samaniego N, et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thrombosis research. 2020;192:23-6.
• Zheng Y, Hua L, Zhao Q, Li M, Huang M, Zhou Y, et al. The level of D-dimer is positively correlated with the severity of mycoplasma pneumoniae pneumonia in children. Frontiers in Cellular and Infection Microbiology. 2021;11:687391.
• Srinivasan A, Kumar N, Scott JX. Evaluation of serum procalcitonin, serum interleukin-6, and interleukin-8 as predictors of serious infection in children with febrile neutropenia and cancer. Indian Journal of Cancer. 2021;58(2):185-9.
• Chaudhary N, Kosaraju K, Bhat K, Bairy I, Borker A. Significance of interleukin-6 (IL-6) and C-reactive protein (CRP) in children and young adults with febrile neutropenia during chemotherapy for cancer: a prospective study. Journal of pediatric hematology/oncology. 2012;34(8):617-23.
• Carcò D, Castorina P, Guardo P, Iachelli V, Pace T, Scirè P, et al. Combination of Interleukin-6, C-Reactive Protein and Procalcitonin Values as Predictive Index of Sepsis in Course of Fever Episode in Adult Haematological Patients: Observational and Statistical Study. Journal of Clinical Medicine. 2022;11(22):6800.