H B Sridevi, Fernandes Anisha Maria, D'souza Sanyo, B Prashantha, Rao Pooja, Shenoy M Suchitra
Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
F1000Res. 2024 Oct 16;13:997. doi: 10.12688/f1000research.154812.2. eCollection 2024.
Cancer and cytotoxic chemotherapy used for its treatment predispose to severe and often fatal infections. Prompt diagnosis and timely antibiotic therapy are crucial, with delays in therapy initiation having high mortality. Complete blood count (CBC) is an inexpensive, standardized, and preliminary investigation for the management and follow-up of cancer patients with diagnostic and prognostic value.
We studied the types of infections associated with various cancers treated with chemotherapy, their etiologies and susceptibility patterns, and the hematological profile of these patients as predictors of infection.
A total of 21 patients (12 solid and 9 hematological malignancies) presented with 31 febrile episodes. White Blood cell count (2079 cells/cu. mm), percentage of neutrophils (52.9%), absolute neutrophil (137.5 cells/cu. mm), and platelet count (1,77,507 cells/cu. mm) were significantly lower in the 11 patients with febrile neutropenia. The absolute lymphocyte count (412.7 cells/cu. mm) was reduced with a strikingly low Neutrophil-to-lymphocyte ratio (NLR) (6.07) in patients with neutropenia. Laboratory and radiological evidence were present in 14/15 episodes of hematological malignancies (p-0.218) whereas unexplained clinical sepsis was common in solid malignancies (p-0.0202). The majority of documented infections were bacterial, caused by gram-negative bacilli, often showing multi-drug resistance. Infectious etiologies were identified in 71.4% of the patients with febrile neutropenia for >5days. Bacterial infections developed within 2 days of neutropenia, whereas viral and fungal infections manifested in prolonged neutropenia. Multi-site infections and higher mortality rates were observed in patients with febrile neutropenia. (p<0.04).
Febrile neutropenia is a common complication among patients receiving chemotherapy for cancer, with an increased risk of morbidity and mortality. Early, rapid, and accurate diagnosis is key to prompt intervention. Hematological parameters such as Total Leukocyte count, platelet count, NLR, and Platelet-to-lymphocyte ratio are promising biomarkers in conjunction with morphological changes in neutrophils, thus proving that CBC and peripheral smears are simple, easily available, cost-effective, and highly dependable screening tools, especially in resource-poor settings.
癌症及其用于治疗的细胞毒性化疗易引发严重且往往致命的感染。及时诊断和适时的抗生素治疗至关重要，治疗开始的延迟会导致高死亡率。全血细胞计数（CBC）是一种用于癌症患者管理和随访的廉价、标准化的初步检查，具有诊断和预后价值。
我们研究了接受化疗的各种癌症相关的感染类型、其病因和药敏模式，以及这些患者作为感染预测指标的血液学特征。
共有21例患者（12例实体瘤和9例血液系统恶性肿瘤）出现31次发热发作。11例发热性中性粒细胞减少患者的白细胞计数（2079个/立方毫米）、中性粒细胞百分比（52.9%）、绝对中性粒细胞计数（137.5个/立方毫米）和血小板计数（177507个/立方毫米）显著较低。中性粒细胞减少患者的绝对淋巴细胞计数（412.7个/立方毫米）降低，中性粒细胞与淋巴细胞比值（NLR）极低（6.07）。血液系统恶性肿瘤的14/15次发作中有实验室和影像学证据（p = 0.218），而实体瘤中不明原因的临床脓毒症很常见（p = 0.0202）。大多数记录在案的感染是由革兰氏阴性杆菌引起的细菌感染，常表现出多重耐药性。发热性中性粒细胞减少持续>5天的患者中，71.4%确定了感染病因。细菌感染在中性粒细胞减少的2天内发生，而病毒和真菌感染在长期中性粒细胞减少时出现。发热性中性粒细胞减少患者出现多部位感染且死亡率较高（p<0.04）。
发热性中性粒细胞减少是接受癌症化疗患者中的常见并发症，发病和死亡风险增加。早期、快速和准确的诊断是及时干预的关键。全白细胞计数、血小板计数、NLR和血小板与淋巴细胞比值等血液学参数与中性粒细胞形态变化相结合是有前景的生物标志物，从而证明CBC和外周血涂片是简单、易于获取、具有成本效益且高度可靠的筛查工具，尤其是在资源匮乏的环境中。
