Assessment Can Help ED Physicians Predict Poor Prognosis for Patients With Febrile Neutropenia

The quick sequential (sepsis-related) organ failure assessment (qSOFA) can help emergency department physicians identify which patients with neutropenia are at risk of a poor prognosis and should receive prompt empirical antimicrobial therapy, according to a new study.

The efficacy of the assessment carries with it a significant potential impact as physicians have a hard time identifying patients at risk of complications. The study also identified pneumonia as a marker of risk.

“Emergency physicians must identify patients who are at risk because the prognosis of patients with severe infection depends on their initial management,” wrote the researchers. “The qSOFA and the presence of pneumonia can be a useful bedside tool for patients with cancer who present with febrile neutropenia in the ED.”

The retrospective study followed patients who presented with febrile neutropenia in the emergency department (ED) from January 2014 to December 2017 in a university hospital in Korea. The 104 patients were divided into 2 groups: those who were admitted into the intensive care unit (ICU) or those who died during hospitalization (case group) and those who were admitted at general wards and were discharged (control group).

The mean age of the patients was 61, and diabetes was the most common comorbidity (18%). While 69 patients had a solid tumor, 35 had hematological malignancies, and among those with solid tumors, the most frequent type of malignancy was breast.

The majority (89) of patients received chemotherapy within 2 months, and the median delay between chemotherapy and ED visit was 12.5 days, ranging from 10 to 15 days.

Patients who died or were admitted to the ICU had lower systolic and diastolic blood pressure and higher pulse rates than those in the control group. Notably, the qSOFA score was significantly higher in the case group than in the control group (.88 vs .36). The score included a systolic blood pressure of 100 mmHg or less, 22 or more breaths per minute, and altered mental status.

While there was no difference observed in complete blood cell counts, the case group had a lower hemoglobin level, platelet count, and HCO₃ level. They also had a higher total bilirubin, creatinine, and C-reactive protein level than the control group.

Looking at the source of infection, the researchers observed that pneumonia was more common in patients who died or were admitted to the ICU (52% vs 16%).

In the multiple logistic regression analysis, mortality was significantly associated with the qSOFA (odds ratio [OR]: 4.62; 95% CI: 1.17-18.22), hemoglobin level (OR: 0.51; 95% CI: 0.33-0.78), total bilirubin level (OR: 7.69; 95% CI: 1.29-45.8), and respiratory tract infection (OR: 29.65; 95% CI: 3.81-230.7).

Reference

Lee S, Kim J, Han S, et al. Prognostic factors predicting poor outcomes in cancer patients with febrile neutropenia in the emergency department: usefulness of aSOFA [published online October 11, 2018]. J Oncol. doi: 10.1155/2018/2183179.