title: Independent factors for prediction of poor outcomes in patients with febrile neutropenia.
abstract: BACKGROUND
  Febrile neutropenia (FN) is a life-threatening condition that requires urgent management in the emergency department (ED). Recent progress in the treatment of neutropenic fever has underscored the importance of risk stratification. In this study, we aimed to determine independent factors for prediction of poor outcomes in patients with FN.
  
  
  METHODS
  We retrospectively evaluated 200 chemotherapy-induced febrile neutropenic patients who visited the ED. Upon arrival at the ED, clinical data, including sex, age, vital signs, underlying systemic diseases, laboratory test results, estimated GFR, blood cultures, CRP, radiologic examinations, and Multinational Association of Supportive Care in Cancer (MASCC) score of all febrile neutropenic patients were obtained. Outcomes were categorized as "poor" if serious complications during hospitalization, including death, occurred.
  
  
  RESULTS
  The platelet count <50 000 cells/mm3 (OR 3.90, 95% CI 1.62-9.43), pulmonary infiltration (OR 3.45, 95% CI 1.48-8.07), hypoproteinemia <6 g/dl (OR 3.30, 95% CI 1.27-8.56), respiratory rate >24/min (OR 8.75, 95% CI 2.18-35.13), and MASCC score <21 (OR 9.20, 95% CI 3.98-21.26) were determined as independent risk factors for the prediction of death. The platelet count <50 000 cells/mm3 (OR 3.93, 95% CI 1.42-10.92), serum CRP >50 mg/dl (OR 3.80, 95% CI 1.68-8.61), hypoproteinemia (OR 7.81, 95% CI 3.43-17.78), eGFR ≤90 ML/min/1.73 m2 (OR 3.06, 95% CI 1.13-8.26), and MASCC score <21 (OR 3.45, 95% CI 1.53-7.79) were determined as independent risk factors for the prediction of poor clinical outcomes of FN patients. Platelet count, protein level, respiratory rate, pulmonary infiltration, CRP, MASCC score, and eGFR were shown to have a significant association with outcome.
  
  
  CONCLUSIONS
  The results of our study may help emergency medicine physicians to prevent serious complications with proper use of simple independent risk factors besides MASCC score.
authors.affiliation: Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Müge
authors.initials: M
authors.lastname: Günalp
authors.affiliation: Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Merve
authors.initials: M
authors.lastname: Koyunoğlu
authors.affiliation: Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Gürler
authors.affiliation: Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Ayça
authors.initials: A
authors.lastname: Koca
authors.affiliation: Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Ilker
authors.initials: I
authors.lastname: Yeşilkaya
authors.affiliation: Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Öner
authors.affiliation: Department of Emergency Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Meltem
authors.initials: M
authors.lastname: Akkaş
authors.affiliation: Department of Emergency Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Nalan
authors.initials: N
authors.lastname: Metin Aksu
authors.affiliation: Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Arda
authors.initials: A
authors.lastname: Demirkan
authors.affiliation: Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Polat
authors.affiliation: Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Atilla Halil
authors.initials: AH
authors.lastname: Elhan
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents