发热性中性粒细胞减少症患者不良预后的预测因素
Independent factors for prediction of poor outcomes in patients with febrile neutropenia.
作者信息
Günalp Müge, Koyunoğlu Merve, Gürler Serdar, Koca Ayça, Yeşilkaya Ilker, Öner Emre, Akkaş Meltem, Metin Aksu Nalan, Demirkan Arda, Polat Onur, Elhan Atilla Halil
机构信息
Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
Department of Emergency Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
出版信息
Med Sci Monit. 2014 Oct 5;20:1826-32. doi: 10.12659/MSM.892269.
BACKGROUND
Febrile neutropenia (FN) is a life-threatening condition that requires urgent management in the emergency department (ED). Recent progress in the treatment of neutropenic fever has underscored the importance of risk stratification. In this study, we aimed to determine independent factors for prediction of poor outcomes in patients with FN.
MATERIAL AND METHODS
We retrospectively evaluated 200 chemotherapy-induced febrile neutropenic patients who visited the ED. Upon arrival at the ED, clinical data, including sex, age, vital signs, underlying systemic diseases, laboratory test results, estimated GFR, blood cultures, CRP, radiologic examinations, and Multinational Association of Supportive Care in Cancer (MASCC) score of all febrile neutropenic patients were obtained. Outcomes were categorized as "poor" if serious complications during hospitalization, including death, occurred.
RESULTS
The platelet count <50 000 cells/mm3 (OR 3.90, 95% CI 1.62-9.43), pulmonary infiltration (OR 3.45, 95% CI 1.48-8.07), hypoproteinemia <6 g/dl (OR 3.30, 95% CI 1.27-8.56), respiratory rate >24/min (OR 8.75, 95% CI 2.18-35.13), and MASCC score <21 (OR 9.20, 95% CI 3.98-21.26) were determined as independent risk factors for the prediction of death. The platelet count <50 000 cells/mm3 (OR 3.93, 95% CI 1.42-10.92), serum CRP >50 mg/dl (OR 3.80, 95% CI 1.68-8.61), hypoproteinemia (OR 7.81, 95% CI 3.43-17.78), eGFR ≤90 ML/min/1.73 m2 (OR 3.06, 95% CI 1.13-8.26), and MASCC score <21 (OR 3.45, 95% CI 1.53-7.79) were determined as independent risk factors for the prediction of poor clinical outcomes of FN patients. Platelet count, protein level, respiratory rate, pulmonary infiltration, CRP, MASCC score, and eGFR were shown to have a significant association with outcome.
CONCLUSIONS
The results of our study may help emergency medicine physicians to prevent serious complications with proper use of simple independent risk factors besides MASCC score.
背景
发热性中性粒细胞减少症（FN）是一种危及生命的疾病，需要在急诊科（ED）进行紧急处理。中性粒细胞减少性发热治疗的最新进展凸显了风险分层的重要性。在本研究中，我们旨在确定预测FN患者不良结局的独立因素。
材料与方法
我们回顾性评估了200名因化疗导致发热性中性粒细胞减少并前往急诊科就诊的患者。所有发热性中性粒细胞减少症患者到达急诊科时，获取其临床数据，包括性别、年龄、生命体征、潜在的全身性疾病、实验室检查结果、估计的肾小球滤过率、血培养、C反应蛋白（CRP）、影像学检查以及多国支持性癌症护理协会（MASCC）评分。如果住院期间发生包括死亡在内的严重并发症，则将结局分类为“不良”。
结果
血小板计数<50000个/立方毫米（比值比[OR]3.90，95%置信区间[CI]1.62 - 9.43）、肺部浸润（OR 3.45，95% CI 1.48 - 8.07）、低蛋白血症<6 g/dl（OR 3.30，95% CI 1.27 - 8.56）、呼吸频率>24次/分钟（OR 8.75，95% CI 2.18 - 35.13）以及MASCC评分<21（OR 9.20，95% CI 3.98 - 21.26）被确定为预测死亡的独立危险因素。血小板计数<50000个/立方毫米（OR 3.93，95% CI 1.42 - 10.92）、血清CRP>50 mg/dl（OR 3.80，95% CI 1.68 - 8.61）、低蛋白血症（OR 7.81，95% CI 3.43 - 17.78）、估算肾小球滤过率（eGFR）≤90 ml/min/1.73平方米（OR 3.06，95% CI 1.13 - 8.26）以及MASCC评分<21（OR 3.45，95% CI 1.53 - 7.79）被确定为预测FN患者不良临床结局的独立危险因素。血小板计数、蛋白水平、呼吸频率、肺部浸润、CRP、MASCC评分和eGFR均显示与结局有显著关联。
结论
我们的研究结果可能有助于急诊医学医生除了使用MASCC评分外，通过合理运用简单的独立危险因素来预防严重并发症。
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