Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, South Korea.
Emerg Med J. 2009 Nov;26(11):802-6. doi: 10.1136/emj.2008.064865.
The purpose of this study was to identify independent factors that can be used to predict whether febrile neutropenic patients who appear healthy at presentation will develop subsequent complications, using variables that are readily available in the emergency department (ED).
The medical records of 192 episodes in which the patients presented to the ED with neutropenic fever resulting from chemotherapy, with an alert mental state and haemodynamic stability were retrospectively reviewed. Endpoints examined were fever response to administered antibiotics, death or severe medical complications during hospitalisation.
Thirty-eight episodes of neutropenic fever with complicated outcomes were identified from among a total of 192 episodes. Three parameters emerged as independent factors for the prediction of neutropenic fever with complications in the multivariate regression analysis: platelet count (130-450 x 10(3) cells/mm(3)) <50 000 cells/mm(3), serum C-reactive protein (CRP, 0.1-1 mg/dl) >10 mg/dl and pulmonary infiltration on chest x ray.
Platelet count, CRP and pulmonary infiltration on chest x ray at presentation could be used to identify febrile neutropenic patients who will develop complications, and these factors may be useful in making treatment-related decisions in the ED.
本研究旨在确定可用于预测表现健康的发热性中性粒细胞减少症患者是否会发生后续并发症的独立因素，所使用的变量在急诊科（ED）中易于获得。
回顾性分析了 192 例因化疗引起中性粒细胞减少性发热并伴有警觉性精神状态和血流动力学稳定的患者在急诊科就诊的病历。检查的终点是给予抗生素后的发热反应、住院期间死亡或严重医疗并发症。
在总共 192 例发热性中性粒细胞减少症中，有 38 例出现复杂的中性粒细胞减少性发热并发症。多变量回归分析中，有三个参数是中性粒细胞减少性发热合并并发症的独立预测因素：血小板计数（130-450 x 10(3) 细胞/mm(3)）<50 000 细胞/mm(3)、血清 C 反应蛋白（CRP，0.1-1 mg/dl）>10 mg/dl 和胸部 X 线片有肺部浸润。
在发热性中性粒细胞减少症患者就诊时的血小板计数、CRP 和胸部 X 线片上的肺部浸润可用于识别可能发生并发症的患者，这些因素可能有助于在急诊科做出与治疗相关的决策。
