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成年菲律宾发热性中性粒细胞减少症患者预后及严重程度的预测因素

Predictors of Outcome and Severity in Adult Filipino Patients with Febrile Neutropenia.

作者信息

Yu Marc Gregory Y, Villalobos Ralph Elvi M, Juan-Bartolome Ma Jasmin Marinela C, Berba Regina P

机构信息

Department of Medicine, Philippine General Hospital, Taft Avenue, Ermita, 1000 Manila, Philippines.

出版信息

Adv Hematol. 2015;2015:920838. doi: 10.1155/2015/920838. Epub 2015 Sep 3.

Abstract

Aim. The study aimed to describe the profile of Filipino febrile neutropenia patients and to determine parameters associated with severe outcomes. Methods. This is a retrospective study of Filipino febrile neutropenia patients admitted to the Philippine General Hospital. Patients were described in terms of clinical presentation and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using regression analysis. Results. 115 febrile episodes in 102 patients were identified. Regression analysis yielded prolonged fever >7 days prior to admission (OR 2.43; 95% CI, 0.77-7.74), isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04-6.98), and nadir absolute neutrophil count (ANC) < 100 during admission (OR 1.96; 95% CI, 0.75-5.12) as significant predictors of poor outcome. Factors that significantly correlated with better outcome were granulocyte colony-stimulating factor (G-CSF) use (OR 0.31; 95% CI, 0.11-0.85) and completeness of antibiotic therapy (OR 0.26; 95% CI, 0.10-0.67). Conclusion. Prolonged fever >7 days prior to admission, positive pathogen on cultures, and nadir ANC < 100 during admission predicted severe outcomes, whereas G-CSF use and complete antibiotic therapy were associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and monitoring.

摘要

目的。本研究旨在描述菲律宾发热性中性粒细胞减少症患者的概况,并确定与严重后果相关的参数。方法。这是一项对入住菲律宾总医院的菲律宾发热性中性粒细胞减少症患者的回顾性研究。根据临床表现对患者进行描述,并根据是否存在严重后果进行分层。然后使用回归分析确定预后因素。结果。在102例患者中识别出115次发热发作。回归分析得出入院前发热持续>7天(比值比2.43;95%置信区间,0.77 - 7.74)、培养物中分离出病原体(比值比2.69;95%置信区间,1.04 - 6.98)以及入院期间中性粒细胞绝对计数最低点(ANC)<100(比值比1.96;95%置信区间,0.75 - 5.12)是不良预后的显著预测因素。与较好预后显著相关的因素是使用粒细胞集落刺激因子(G - CSF)(比值比0.31;95%置信区间,0.11 - 0.85)和抗生素治疗的完整性(比值比0.26;95%置信区间,0.10 - 0.67)。结论。入院前发热持续>7天、培养物中病原体阳性以及入院期间ANC最低点<100预测严重后果,而使用G - CSF和完整的抗生素治疗与较好预后相关。这些预后变量可能有助于识别需要更强化治疗和监测的患者。

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