title: Capillary refill time in febrile neutropenia.
abstract: BACKGROUND
  Febrile neutropenia is a major cause of morbidity and mortality in patients presenting this condition following chemotherapy against several malignancies.
  
  
  OBJECTIVE
  To evaluate if capillary refill time (CRT) allows the prediction of poor clinical outcome with or without antibiotic dose escalation.
  
  
  METHODS
  Capillary refill time was assessed in 50 patients with febrile neutropenia at its nadir after chemotherapy admitted to the emergency department at Hospital Universitário de Brasília. All patients included had a minimum average arterial blood pressure of 75 mmHg, O2/FiO2 saturation rate > 300, and 15 points in the Glasgow coma scale. Inclusion depended on at least three of the systemic inflammatory response syndrome (SIRS) criteria, suspected infection, and neutropenia after chemotherapy. Capillary refill time was calculated by pressing the index finger for 15 seconds, and then timing the return to the initial color. We studied whether there is a relationship between CRT and antibiotic escalation. The gold standard used to gravity was the level of lactate.
  
  
  RESULTS
  31 patients had CRT ≥ 3 seconds, which it is associated with increased serum concentration of lactate (> 2 mmol/L; p<0.05). 32 patients underwent antibiotic escalation, which it is associated with CRT ≥ 3 seconds (p<0.01).
  
  
  CONCLUSIONS
  CRT higher than three seconds was effective to predict antibiotic escalation.
authors.affiliation: MSc in Medicine from Universidade de Brasília (UnB), Brasília, DF, Brazil.
authors.forename: Adriana Gherardi da
authors.initials: AG
authors.lastname: Ponte
authors.affiliation: PhD in Hematology from Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: Rafael Henrique
authors.initials: RH
authors.lastname: Jácomo
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D002196:Capillaries / Q000503:physiopathology*; D064147:Febrile Neutropenia / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D019344:Lactic Acid