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Jantunen E, Hämäläinen S, Pulkki K, Juutilainen A. Novel biomarkers to identify complicated course of febrile neutropenia in hematological patients receiving intensive chemotherapy. Eur J Haematol 2024; 113:392-399. [PMID: 38961525 DOI: 10.1111/ejh.14264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024]
Abstract
Febrile neutropenia (FN) is a common consequence of intensive chemotherapy in hematological patients. More than 90% of the patients with acute myeloid leukemia (AML) develop FN, and 5%-10% of them die from subsequent sepsis. FN is very common also in autologous stem cell transplant recipients, but the risk of death is lower than in AML patients. In this review, we discuss biomarkers that have been evaluated for diagnostic and prognostic purposes in hematological patients with FN. In general, novel biomarkers have provided little benefit over traditional inflammatory biomarkers, such as C-reactive protein and procalcitonin. The utility of most biomarkers in hematological patients with FN has been evaluated in only a few small studies. Although some of them appear promising, much more data is needed before they can be implemented in the clinical evaluation of FN patients. Currently, close patient follow-up is key to detect complicated course of FN and the need for further interventions such as intensive care unit admission. Scoring systems such as q-SOFA (Quick Sequential Organ Failure Assessment) or NEWS (National Early Warning Sign) combined with traditional and/or novel biomarkers may provide added value in the clinical evaluation of FN patients.
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Affiliation(s)
- Esa Jantunen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Sari Hämäläinen
- Department of Medicine, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Kari Pulkki
- Diagnostic Center, Helsinki University Hospital and Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
- Institute of Clinical Medicine/Clinical Chemistry, University of Eastern Finland, Kuopio, Finland
| | - Auni Juutilainen
- Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland
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Judickas Š, Stasiūnaitis R, Žučenka A, Žvirblis T, Šerpytis M, Šipylaitė J. Outcomes and Risk Factors of Critically Ill Patients with Hematological Malignancy. Prospective Single-Centre Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121317. [PMID: 34946262 PMCID: PMC8707137 DOI: 10.3390/medicina57121317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/06/2023]
Abstract
Background and Objectives: Oncohematological patients have a high risk of mortality when they need treatment in an intensive care unit (ICU). The aim of our study is to analyze the outcomes of oncohemathological patients admitted to the ICU and their risk factors. Materials and Methods: A prospective single-center observational study was performed with 114 patients from July 2017 to December 2019. Inclusion criteria were transfer to an ICU, hematological malignancy, age >18 years, a central line or arterial line inserted or planned to be inserted, and a signed informed consent form. Univariate and multivariable logistic regression models were used to evaluate the potential risk factors for ICU mortality. Results: ICU mortality was 44.74%. Invasive mechanical ventilation in ICU was used for 55.26% of the patients, and vasoactive drugs were used for 77.19% of patients. Factors independently associated with it were qSOFA score ≥2, increase of SOFA score over the first 48 h, mechanical ventilation on the first day in ICU, need for colistin therapy, lower arterial pH on arrival to ICU. Cut-off value of the noradrenaline dose associated with ICU mortality was 0.21 μg/kg/min with a ROC of 0.9686 (95% CI 0.93-1.00, p < 0.0001). Conclusions: Mortality of oncohematological patients in the ICU is high and it is associated with progression of organ dysfunction over the first 48 h in ICU, invasive mechanical ventilation and need for relatively low dose of noradrenaline. Despite our findings, we do not recommend making decisions regarding treatment limitations for patients who have reached cut-off dose of noradrenaline.
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Affiliation(s)
- Šarūnas Judickas
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu Str. 2, 08661 Vilnius, Lithuania; (M.Š.); (J.Š.)
- Correspondence:
| | - Raimundas Stasiūnaitis
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio Str. 21/27, 03101 Vilnius, Lithuania;
| | - Andrius Žučenka
- Clinic of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu Str. 2, 08661 Vilnius, Lithuania;
| | - Tadas Žvirblis
- Department of Mechanics and Material Engineering, Faculty of Mechanics, Vilnius Gediminas Technical University Vilnius, J. Basanaviciaus Str. 28, 03224 Vilnius, Lithuania;
| | - Mindaugas Šerpytis
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu Str. 2, 08661 Vilnius, Lithuania; (M.Š.); (J.Š.)
| | - Jūratė Šipylaitė
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu Str. 2, 08661 Vilnius, Lithuania; (M.Š.); (J.Š.)
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Mishra K, Kumar S, Ninawe S, Bahl R, Meshram A, Singh K, Jandial A, Sahu KK, Sandal R, Khera S, Yanamandra U, Khurana H, Kumar R, Kapoor R, Sharma S, Singh J, Das S, Ahuja A, Somasundaram V, Chaterjee T. The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings. Ther Adv Infect Dis 2021; 8:20499361211036592. [PMID: 34394928 PMCID: PMC8358573 DOI: 10.1177/20499361211036592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days (p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 (p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.
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Affiliation(s)
- Kundan Mishra
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Suman Kumar
- DM (Clinical Hematology), Prof & Head of the Department, Department of Clinical Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, 110010, India
| | - Sandeep Ninawe
- Department of Microbiology, Army Hospital (Research & Referral) Delhi, India
| | - Rajat Bahl
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Ashok Meshram
- Department of Internal Medicine, INHS Asvini, Mumbai, MH, India
| | - Kanwaljeet Singh
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Aditya Jandial
- Department of Internal Medicine, PGIMER, Chandigarh, CH, India
| | - Kamal Kant Sahu
- Hematology & Medical Oncology Fellow (PGY 4), Huntsman Cancer Institute, University of Utah, Salt Lake City, 84112, Utah, USA
| | - Rajeev Sandal
- Department of Radiotherapy and Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sanjeev Khera
- Department of Pediatrics, Army Hospital (Research & Referral) Delhi, India
| | - Uday Yanamandra
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India
| | - Harshit Khurana
- Department of Internal Medicine, Command Hospital (Air Force), Bangaluru, KA, India
| | - Rajiv Kumar
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Rajan Kapoor
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Sanjeevan Sharma
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Jasjit Singh
- Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Satyaranjan Das
- Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi
| | - Ankur Ahuja
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Venkateshan Somasundaram
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
| | - Tathagat Chaterjee
- Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India
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Gudiol C, Albasanz-Puig A, Cuervo G, Carratalà J. Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance. Front Med (Lausanne) 2021; 8:636547. [PMID: 33869250 PMCID: PMC8044357 DOI: 10.3389/fmed.2021.636547] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/08/2021] [Indexed: 12/23/2022] Open
Abstract
Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates. The worldwide emergence of antimicrobial resistance is of special concern in this population because any delay in starting adequate empirical antibiotic therapy can lead to poor outcomes. In this review, we aim to address: (1) the mechanisms involved in the development of sepsis and septic shock in these patients; (2) the risk factors associated with a worse prognosis; (3) the impact of adequate initial empirical antibiotic therapy given the current era of widespread antimicrobial resistance; and (4) the optimal management of sepsis, including adequate and early source control of infection, optimized antibiotic use based on the pharmacokinetic and pharmacodynamics changes in these patients, and the role of the new available antibiotics.
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Affiliation(s)
- Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Adaia Albasanz-Puig
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
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