Krishnamani Kalpathi, Gandhi Linga Vijay, Sadashivudu Gundeti, Raghunadharao Digumarti
Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Director, Homi Bhabha Cancer Hospital & Research Centre, Aganampudi, Visakhapatnam 530053, Andhra Pradesh, India.
South Asian J Cancer. 2017 Jan-Mar;6(1):25-27. doi: 10.4103/2278-330X.202565.
Febrile neutropenia (FN) is common in cancer patients particularly hematologic malignancies due to intensive cytotoxic chemotherapy. It is an important cause of morbidity, mortality and treatment delays. The risk is greater in patients with ANC < 500/ mm3 and increases dramatically in those with ANC < 100/ mm3 and duration of neutropenia more than 1 week.
The purpose of this study was to evaluate the incidence, demographic characteristics, clinical profile, mortality, outcome and factors affecting the outcome in patients with febrile neutropenia (FN) admitted at our Center between January 2011 and November 2012.
All cases of FN admitted in our Institute between January 2011 and November 2012 were analyzed. Data was analyzed using IBM statistic SPSS version 19.
A total of 333 episodes of FN were reviewed. Hematologic malignancies accounted for 299 (89.7%) episodes and 88% of all the episodes had grade 4 neutropenia. There was a significant association noted between high serum bilirubin, creatinine and outcome. Isolation of an organism from blood culture, positive findings on chest X-ray and fungal infection was associated with higher mortality. Association between transfusion requirements and outcome was analyzed and it was observed that patients who had multiple component transfusions vs single component ones were at a significantly higher risk of death. There were only 7 deaths noted among the patient population.
Leukemias are the leading cause of FN at our Institute. Higher bilirubin, creatinine, chest imaging favoring pneumonia, positive isolates and multiple transfusions had significant association with mortality. Large scale prospective studies are needed to determine the association of preemptive therapy with higher mortality. The outcome of high risk FN in this study is favorable.
发热性中性粒细胞减少症（FN）在癌症患者中很常见，尤其是在接受强化细胞毒性化疗的血液系统恶性肿瘤患者中。它是发病、死亡和治疗延迟的重要原因。中性粒细胞绝对计数（ANC）<500/mm³ 的患者风险更高，而 ANC<100/mm³ 且中性粒细胞减少持续时间超过 1 周的患者风险会急剧增加。
本研究的目的是评估 2011 年 1 月至 2012 年 11 月期间在本中心住院的发热性中性粒细胞减少症（FN）患者的发病率、人口统计学特征、临床概况、死亡率、结局以及影响结局的因素。
对 2011 年 1 月至 2012 年 11 月期间我院收治的所有 FN 病例进行分析。使用 IBM 统计软件 SPSS 19 版进行数据分析。
共回顾了 333 例 FN 发作病例。血液系统恶性肿瘤占 299 例（89.7%），所有发作病例中有 88% 为 4 级中性粒细胞减少。血清胆红素、肌酐水平与结局之间存在显著关联。血培养分离出微生物、胸部 X 光检查阳性结果以及真菌感染与较高的死亡率相关。分析了输血需求与结局之间的关联，发现接受多种成分输血的患者与接受单一成分输血的患者相比，死亡风险显著更高。患者群体中仅记录到 7 例死亡。
白血病是我院 FN 的主要原因。较高的胆红素、肌酐水平、提示肺炎的胸部影像学表现、阳性分离株以及多次输血与死亡率显著相关。需要进行大规模前瞻性研究以确定抢先治疗与较高死亡率之间的关联。本研究中高危 FN 的结局较好。
