title: Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients.
abstract: BACKGROUND
  Neutropenic patients are at risk of abdominal complications and yet the incidence and impact of these complications on patients' morbidity and mortality have not been sufficiently evaluated. We aimed to assess a clinical rule for early detection of abdominal complications leading to death or transfer to intensive care in patients with chemotherapy-associated neutropenia.
  
  
  METHODS
  This observational multicenter study was carried out in seven German hematology-oncology departments. For inclusion, neutropenia of at least 5 consecutive days was required. Risk factors for "transfer to intensive care" and "death" were assessed by backward-stepwise binary logistic regression analyses. Chemotherapy-associated bowel syndrome was defined as a combination of fever (T ≥37.8 °C) and abdominal pain and/or lack of bowel movement for 72 hours or more. Five hundred and twenty-one neutropenic episodes were documented in 359 patients.
  
  
  RESULTS
  The incidence of chemotherapy-associated bowel syndrome was 126/359 (35%) in first episodes of neutropenia. Transfer to intensive care occurred in 41/359 (11%) and death occurred in 17/359 (5%) first episodes. Chemotherapy-associated bowel syndrome and duration of neutropenia were identified as risk factors for transfer to intensive care (P<0.001; OR 4.753; 95% CI 2.297-9.833, and P=0.003; OR 1.061/d; 95% CI 1.021-1.103). Chemotherapy-associated bowel syndrome and mitoxantrone administration were identified as risk factors for death (P=0.005; OR 4.611; 95% CI 1.573-13.515 and P=0.026; OR 3.628; 95% CI 1.169-11.256).
  
  
  CONCLUSIONS
  The occurrence of chemotherapy-associated bowel syndrome has a significant impact on patients' outcome. In future interventional clinical trials, this definition might be used as a selection criterion for early treatment of patients at risk of severe complications.
authors.affiliation: Hospital of the University of Cologne, Kerpener Straße 62, 50937 Köln Germany. maria.vehreschild@ctuc.de
authors.forename: Maria J G T
authors.initials: MJ
authors.lastname: Vehreschild
authors.forename: Arne M K
authors.initials: AM
authors.lastname: Meissner
authors.forename: Oliver Andreas
authors.initials: OA
authors.lastname: Cornely
authors.forename: Georg
authors.initials: G
authors.lastname: Maschmeyer
authors.forename: Silke
authors.initials: S
authors.lastname: Neumann
authors.forename: Marie
authors.initials: M
authors.lastname: von Lilienfeld-Toal
authors.forename: Meinholf
authors.initials: M
authors.lastname: Karthaus
authors.forename: Mohammed
authors.initials: M
authors.lastname: Wattad
authors.forename: Peter
authors.initials: P
authors.lastname: Staib
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Hildegard
authors.initials: H
authors.lastname: Christ
authors.forename: Jörg Janne
authors.initials: JJ
authors.lastname: Vehreschild
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000139:chemically induced* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects*; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality*; D009503:Neutropenia / Q000139:chemically induced / Q000401:mortality; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D008942:Mitoxantrone