title: Risk factors associated with complications in patients with chemotherapy-induced febrile neutropenia in emergency department.
abstract: Febrile neutropenia caused by chemotherapy is a frequent medical emergency associated with severe complications in the emergency department (ED). Timely administration of antibiotics is believed to improve patient outcomes for several infectious diseases such as pneumonia and sepsis but has not been thoroughly evaluated for reducing risk of complications in chemotherapy-induced febrile neutropenia. The aim of this study was to evaluate associations between the risk factors and serious complications in patients presenting to the ED with febrile neutropenia. We reviewed the health information system database to identify a retrospective cohort of patients with febrile neutropenia who visited the ED of a tertiary medical hospital from January to December 2008. Only episodes of febrile neutropenia caused by chemotherapy for underlying cancer were included. Serious complications during hospitalization were defined as unstable hemodynamic status, respiratory distress, altered mental status, newly developed arrhythmia that required intervention, and death during hospitalization. Univariate and multivariate logistic regression analysis was performed to determine potential factors associated with serious complications. We further use decision tree approach to help analyze variables. Among a total of 81 febrile neutropenic episodes in 78 patients, 25 (30.8%) episodes of serious complications were identified. Latency of the first dose of antibiotics, pneumonia and platelet counts ≤ 50,000/mm(3) were identified as independent factors associated with serious complications of febrile neutropenia. Earlier administration of antibiotics is associated with fewer complications in patients presenting to the ED with febrile neutropenia.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Jiun-Jen
authors.initials: JJ
authors.lastname: Lynn
authors.forename: Kuan-Fu
authors.initials: KF
authors.lastname: Chen
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Weng
authors.forename: Te-Fa
authors.initials: TF
authors.lastname: Chiu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000097:blood / Q000453:epidemiology*; D060085:Coinfection / Q000097:blood / Q000453:epidemiology; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology; D010976:Platelet Count; D011014:Pneumonia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D012372:ROC Curve; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; chemotherapy; complications; febrile neutropenia; prediction; risk factors