J Korean Soc Emerg Med.  2000 Sep;11(3):305-315.

Risk Prediction Factors in Febrile Neutropenic Patients

• Jung JS
• Kwon KY
• Kim KS
• Lim YS
• Rhee JE
• Suh GJ
• Youn YK

Abstract

BACKGROUND: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department.
METHODS
This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis.
RESULTS
Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17.2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr<75ml/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3).
CONCLUSION
The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-predication factors in febrile neutropenia at the time of visiting the emergency department.

MeSH Terms

Comorbidity
Emergency Service, Hospital
Febrile Neutropenia
Fever
Humans
Incidence
Medical Records
Mortality
Neutropenia
Retrospective Studies
Seoul
Shock, Septic
Thorax
Vital Signs