Retrospective study on the management of patients admitted for febrile neutropenia and considered to be at low risk at the Centre Hospitalier Universitaire de Québec.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18762-e18762
Author(s):  
Tommy Jean ◽  
Julie Lemieux ◽  
Geneviève Soucy ◽  
Francis Caron ◽  
Dominique Leblanc
Keyword(s):  
Retrospective Study ◽  
Febrile Neutropenia ◽  
Outpatient Treatment ◽  
Significant Proportion ◽  
Low Risk ◽  
University Hospital ◽  
Quebec City ◽  
Cell Transplant ◽  
Transplant Patients ◽  
Mascc Score

e18762 Background: Febrile neutropenia is a serious complication of chemotherapy leading to hospitalization in cancer patients. According to a practice guidelines published by ASCO (American Society of clinical Oncology) and IDSA (Infectious Diseases Society of American) in 2018, patients meeting the criteria for low-risk neutropenia according to the MASCC score (Multinational Association for Supportive Care in Cancer Score) could be treated as outpatient and thus avoid hospitalization. The objective of the study was to assess the number and proportion of patients who were hospitalized for febrile neutropenia in university hospital that would have met the low risk criteria of febrile neutropenia. We also wanted to know if these patients had experienced a favorable outcome during hospitalization. Methods: We performed a retrospective study including all patients admitted for febrile neutropenia in 3 hospitals in Quebec City during the period from January 1, 2018 to December 31, 2019. We excluded patients with leukemia, as well as stem cell transplant patients. The chart review retrospectively established the MASCC score for each patient. We also established according to predefined criteria whether the clinical course was favorable or unfavorable. Results: A total of 177 hospitalizations met our inclusion criteria. We found that 101/177 (57.1%) of hospitalized patients met the criteria for low-risk neutropenia according to the MASCC score (score of 21 and above). Of this number 74/177 (41.8%) presented all the criteria suggested for receiving outpatient treatment. In these patients 70/177 (39.5%) presented a favorable evolution during hospitalization and thus 4/177 (2.3%) presented an unfavorable evolution. Among these, 2 patients presented with infections considered major (2 bacteremia), 1 patient developed acute renal failure, and 1 other patient developed delirium. There was no death or admission to the intensive care unit in these 4 patients. Conclusions: According to this retrospective study, about 40% of patients admitted for febrile neutropenia filled the criteria of low risk febrile neutropenia and could be treated as outpatient. Given this represents a significant proportion of patients, a protocol for systematic follow-up of outpatient treatment with low-risk febrile neutropenia should be put in place.

Outpatient Treatment with Intravenous Antimicrobial Therapy in Patients with Febrile Neutropenia and Hematologic Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4717-4717
Author(s):  
Marcelo Bellesso ◽  
Luis Fernando Pracchia ◽  
Lucia Dias ◽  
Dalton Chamone ◽  
Pedro Dorlhiac-Llacer
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Serum Creatinine ◽  
Pulse Oximetry ◽  
Antimicrobial Therapy ◽  
Outpatient Treatment ◽  
Laboratory Data ◽  
Hematologic Malignancies ◽  
Initial Therapy ◽  
Low Risk

Abstract OBJECTIVES: The purpose of this study is to evaluate outcomes like success of the initial therapy; failure of outpatient treatment and death in outpatient treatment with intravenous antimicrobial therapy in patients with febrile neutropenia (FN) and hematologic malignancies. In addition, it was compared clinics, laboratory data and Multinational Association for Supportive Care of Cancer index (MASCC) with failure of outpatient treatment and death. PATIENTS AND METHODS: In a retrospective study we evaluated FN following chemotherapy events that were treated initially with Cefepime, with or without Teicoplanin. RESULTS: Of the 178 FN episodes in 128 patients, it was observed success of initial therapy in 63.5% events, failure of outpatient treatment in 20.8% and death in 6.2%. In multivariate analysis, significant risks of failure of outpatient treatment were smoking (OR: 3.14, IC: 1.14 – 8.66, p=0.027) and serum creatinine > 1.2mg/dL (OR: 7.97, IC: 2.19 – 28.95, p = 0.002). About death, the risk was pulse oximetry < 95% (OR: 5.8, IC: 1.50 – 22.56, p = 0.011). Analyzing MASCC index, 165 events were classified as low risk and 13 as high-risk. Failure of outpatient treatment were reported in connection with 7 (53.8%) high-risk episodes and 30 (18.2%) low-risk, p=0.006. In addition, death in 7 (4.2%) lowrisk and 4 (30.8%) high-risk events, p=0.004. CONCLUSIONS: The outpatient treatment with intravenous antibiotic was satisfactory. The risks: smoking, serum creatinine elevated and pulse oximetry should be considered in FN evaluation. It was validated MASCC index in Brazilian population.

scholarly journals Ambulatory Outpatient Management of patients with low risk febrile neutropaenia

2015 ◽  
Vol 14 (4) ◽  
pp. 178-181
Author(s):  
Timothy Cooksley ◽  
◽  
Mark Holland ◽  
Jean Klastersky ◽  
◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Cost Savings ◽  
Scoring Systems ◽  
Low Risk ◽  
Ambulatory Setting ◽  
Medical Complications ◽  
Mascc Score ◽  
Risk Patients ◽  
Reduced Risk ◽  
Avoidance Cost

Patients with febrile neutropenia are a heterogeneous group with only a minority developing significant medical complications. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score, have been developed and validated to identify low risk patients. Caring for patients with low risk febrile neutropenia in an ambulatory setting is proven to be safe and effective. Benefits include admission avoidance, cost savings and reduced risk of nosocomial infections, as well as improved patient experience and satisfaction. Implementation of an ambulatory pathway for low risk febrile neutropenia provides an excellent opportunity for Acute Physicians and Oncologists to collaborate in delivering care for this group of patients.

scholarly journals Use of MASCC score in the inpatient management of febrile neutropenia: a single-center retrospective study

2021 ◽  
Author(s):  
Prarthna V. Bhardwaj ◽  
Megan Emmich ◽  
Alexander Knee ◽  
Fatima Ali ◽  
Ritika Walia ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Febrile Neutropenia ◽  
Single Center ◽  
Mascc Score ◽  
Inpatient Management

scholarly journals Substantiation of Multinational Association for Supportive Care in Cancer (MASCC) Score in Risk Assessment of Febrile Neutropenic Patients in Hematological Disorders: A Regional Study from Pakistan

2021 ◽  
Vol 5 (3) ◽  
pp. 99-103
Author(s):  
Qurratul Ain Rizvi ◽  
◽  
Aisha Jamal ◽  
Naveena Fatima ◽  
Munira Borhany ◽  
...  
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Supportive Care ◽  
Medical Condition ◽  
Low Risk ◽  
Management Approach ◽  
Medical Conditions ◽  
Hematological Disorders ◽  
Mascc Score ◽  
Neutropenic Patients

Abstract: Background: The incidence of neutropenia in hematological malignancies comprises of huge burden of febrile neutropenia. Multinational Association of Supportive Care in Cancer (MASCC) risk index score is the most widely used model for forecast of complications. Objective: The aim of this study was to determine diagnostic accuracy of MASCC scoring system in febrile neutropenia patients suffering from hematological disorders. Materials & Methods: Patients suffering from hematological disorders and presenting with febrile neutropenia were stratified into low and high risk groups according to MASSC score. The standard score range from 0 to 26 points; score of more than or equals to 21 were considered to be low risk and score of less than 21 was high-risk category. As an in-patient at National Institute of Blood Disease & Bone Marrow Transplantation, they were followed over the course of illness for development of any serious medical condition until resolution of febrile neutropenia. Results: Of 217 patients, serious medical conditions were documented in (63%) of individuals among the high-risk group cohort and (13%) developed serious medical conditions in low-risk cohort. Major disease encountered was acute leukemia (69%). Hypotension 14 (22.2%) and hepatic failure 14 (22.2%) were among the two most common variables of established serious medical condition. The overall sensitivity and specificity of MASCC score was 69.8% and 81.8%, with the positive and negative predictive value of 61.1% and 86.8% respectively. Conclusion: The score has been re-validated in this study and determined its significance in ascertainment of high-risk cohort among febrile neutropenic patients in the current era, thereby helping the physicians to tailor the management approach accordingly. Keywords: MASCC, Febrile neutropenia, Leukemia, Hematological disorders, Cytotoxic chemotherapy.

scholarly journals Outpatient Treatment for Low‐Risk Febrile Neutropenia

2019 ◽  
Vol 26 (12) ◽  
pp. 1393-1394
Author(s):  
Michael Gottlieb ◽  
Alex Koyfman ◽  
Brit Long
Keyword(s):  
Febrile Neutropenia ◽  
Outpatient Treatment ◽  
Low Risk

scholarly journals CMV IN HEMATOPOIETIC STEM CELL TRANSPLANTATION

2016 ◽  
Vol 8 ◽  
pp. 2016031 ◽  
Author(s):  
Rafael De la Camara
Keyword(s):  
Stem Cell ◽  
Negative Impact ◽  
Significant Proportion ◽  
Organ Transplant ◽  
Morbidity And Mortality ◽  
Solid Organ ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Transplant Patients ◽  
Cmv Disease

Due to its negative impact in the outcome of stem cell transplant (SCT) and solid organ transplant patients (SOT) CMV has been called “the troll of transplantation”. One of the greatest advances in the management of SCT has been the introduction of the preemptive strategy. Since its introduction, the incidence of the viremia, as expected, remains unchanged but there has been a marked decline in the incidence of early CMV disease. But in spite of the advances in prevention of CMV disease, CMV is still today an important cause of morbidity and mortality. Late CMV disease is still occurring in a significant proportion of patients and the so-called indirect effects of CMV are causing significant morbidity and mortality. Fortunately, there have been several advances in the development of new antivirals, adoptive immunotherapy and DNA-CMV vaccines that might transform the management of CMV in the near future. 

scholarly journals Serum caspase-cleaved cytokeratin-18 fragment as a prognostic biomarker in hematological patients with febrile neutropenia

2021 ◽  
Author(s):  
Carina Intke ◽  
Sini Korpelainen ◽  
Marika Lappalainen ◽  
Matti Vänskä ◽  
Sari Hämäläinen ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Blood Culture ◽  
Febrile Neutropenia ◽  
Prognostic Marker ◽  
Fatal Outcome ◽  
University Hospital ◽  
Cell Transplant ◽  
Cytokeratin 18 ◽  
Intensive Care Unit Treatment ◽  
Hematological Patients

AbstractThe study aim was to determine the benefit of the measurement of serum caspase-cleaved cytokeratin-18 (CK-18) fragment as a prognostic marker of febrile neutropenia (FN) in hematological patients. The study population consisted of 86 consecutive patients with FN who received intensive chemotherapy for hematological malignancy at the adult hematology ward of Kuopio University Hospital. Twenty-three patients (27%) had acute myeloid leukemia, and 63 patients (73%) were autologous stem cell transplant recipients. Serum caspase-cleaved CK-18 fragment M30, C-reactive protein (CRP) and procalcitonin (PCT) were measured at the onset of FN (d0), on day 1 (d1), and on day 2 (d2). Eight patients (9%) developed severe sepsis, including three patients with septic shock. Eighteen patients (21%) had a blood culture-positive infection. Serum CK-18 fragment peaked on the first day after fever onset in patients with severe sepsis. Higher CK-18 level was associated with severe sepsis, intensive care unit treatment, and fatal outcome, but not with blood culture positivity. In ROC curve analysis, d1 serum CK-18 fragment predicted severe sepsis with an area under the curve (AUC) of 0.767, CRP with an AUC of 0.764, and PCT with an AUC of 0.731. On d2, the best predictive capacity was observed for CRP with an AUC of 0.832. The optimal cutoff of caspase-cleaved CK-18 fragment M30 for predicting severe sepsis was 205 U/L on d1. In hematological patients, serum CK-18 fragment was found to be a potential prognostic marker of severe sepsis at early stages of FN.

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