Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Hematol Oncol. 2013 Dec;31(4):189-96. doi: 10.1002/hon.2040. Epub 2013 Jan 9.
Febrile neutropenia caused by chemotherapy is a frequent medical emergency associated with severe complications in the emergency department (ED). Timely administration of antibiotics is believed to improve patient outcomes for several infectious diseases such as pneumonia and sepsis but has not been thoroughly evaluated for reducing risk of complications in chemotherapy-induced febrile neutropenia. The aim of this study was to evaluate associations between the risk factors and serious complications in patients presenting to the ED with febrile neutropenia. We reviewed the health information system database to identify a retrospective cohort of patients with febrile neutropenia who visited the ED of a tertiary medical hospital from January to December 2008. Only episodes of febrile neutropenia caused by chemotherapy for underlying cancer were included. Serious complications during hospitalization were defined as unstable hemodynamic status, respiratory distress, altered mental status, newly developed arrhythmia that required intervention, and death during hospitalization. Univariate and multivariate logistic regression analysis was performed to determine potential factors associated with serious complications. We further use decision tree approach to help analyze variables. Among a total of 81 febrile neutropenic episodes in 78 patients, 25 (30.8%) episodes of serious complications were identified. Latency of the first dose of antibiotics, pneumonia and platelet counts ≤ 50,000/mm(3) were identified as independent factors associated with serious complications of febrile neutropenia. Earlier administration of antibiotics is associated with fewer complications in patients presenting to the ED with febrile neutropenia.
中性粒细胞减少伴发热由化疗引起，是急诊科（ED）严重并发症相关的常见医学急症。及时给予抗生素被认为可改善肺炎和败血症等多种传染病患者的结局，但对于降低化疗诱导性中性粒细胞减少伴发热的并发症风险尚未进行充分评估。本研究旨在评估 ED 中性粒细胞减少伴发热患者的危险因素与严重并发症之间的相关性。我们查阅了健康信息系统数据库，以确定 2008 年 1 月至 12 月期间在某三级医院 ED 就诊的、因基础癌症化疗引起的中性粒细胞减少伴发热患者的回顾性队列。仅纳入由化疗引起的中性粒细胞减少伴发热病例。住院期间的严重并发症定义为血流动力学不稳定、呼吸窘迫、精神状态改变、新发需要干预的心律失常以及住院期间死亡。采用单变量和多变量逻辑回归分析确定与严重并发症相关的潜在因素。我们进一步采用决策树方法来帮助分析变量。在 78 例患者的 81 次中性粒细胞减少伴发热发作中，有 25 次（30.8%）发生严重并发症。抗生素首剂使用的潜伏期、肺炎和血小板计数≤50,000/mm3 是与中性粒细胞减少伴发热严重并发症相关的独立因素。ED 中性粒细胞减少伴发热患者抗生素使用越早，并发症越少。
