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Ono Y, Hayama N, Hattori S, Ito Y, Oguma T, Sakamaki F, Asano K. Can MASCC and CISNE scores predict delays of lung cancer chemotherapy after febrile neutropenia? Thorac Cancer 2022; 13:3504-3509. [PMID: 36330990 PMCID: PMC9750814 DOI: 10.1111/1759-7714.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Febrile neutropenia (FN) during cancer chemotherapy can lead to morbidity and mortality. The Multinational Association of Supportive Care in Cancer (MASCC) and clinical index of stable febrile neutropenia (CISNE) scores have been widely used to predict the risk of severe medical complications in patients with FN; however, there are few tools for predicting chemotherapy delays or discontinuation after FN. METHODS Patients admitted to two university hospitals between 2014 and 2018 with a FN diagnosis during the first cycle of chemotherapy for lung cancer were reviewed retrospectively. RESULTS Among 539 patients who received 813 courses of chemotherapy for lung cancer, 49 (9%) developed FN during the first treatment cycle. Although all the patients recovered from their primary infection, 19 patients (38.8%) developed serious medical complications, 11 (22.4%) were unable to resume chemotherapy and one (2.0%) declined to resume chemotherapy, and nine (18.4%) died within 90 days. Patients who failed to resume chemotherapy had a lower MASCC score (median 8.5 vs. 17, p < 0.01) and a higher CISNE score (median 3 vs. 1, p < 0.01) at the onset of FN. The specificity to predict the patient who failed to resume chemotherapy was 90% or more with MASCC score ≤9 or CISNE score ≥3, with the sensitivity of 61%. MASCC score ≤ 16 can also be a sensitive indicator with the sensitivity and specificity of 89 and 52%, respectively. CONCLUSION The MASCC and CISNE scores are useful in identifying lung cancer patients who are unable to resume chemotherapy as scheduled after the onset of FN.
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Affiliation(s)
- Yoshitaka Ono
- Division of Pulmonary Medicine, Department of MedicineTokai University School of MedicineIseharaJapan
| | - Naoki Hayama
- Division of Pulmonary Medicine, Department of MedicineTokai University School of MedicineIseharaJapan
| | - Shigeaki Hattori
- Division of Pulmonary Medicine, Department of MedicineTokai University School of MedicineIseharaJapan
| | - Yoko Ito
- Division of Pulmonary Medicine, Department of MedicineTokai University School of MedicineIseharaJapan
| | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of MedicineTokai University School of MedicineIseharaJapan
| | - Fumio Sakamaki
- Division of Pulmonary Medicine, Department of MedicineTokai University Hachioji HospitalTokyoJapan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of MedicineTokai University School of MedicineIseharaJapan
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Bhardwaj PV, Emmich M, Knee A, Ali F, Walia R, Roychowdhury P, Clark J, Sridhar A, Lagu T, Loh KP. Use of MASCC score in the inpatient management of febrile neutropenia: a single-center retrospective study. Support Care Cancer 2021; 29:5905-5914. [PMID: 33761002 PMCID: PMC7987550 DOI: 10.1007/s00520-021-06154-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/15/2021] [Indexed: 01/21/2023]
Abstract
Purpose The Multinational Association for Supportive Care in Cancer (MASCC) score is used to risk stratify outpatients with febrile neutropenia (FN). However, it is rarely used in hospital settings. We aimed to describe management, use of MASCC score, and outcomes among hospitalized patients with FN. Methods We conducted a retrospective cohort study of patients with cancer and FN. We collected patient demographics, cancer characteristics, microbiological profile, MASCC score, utilization of critical care therapies, documentation of goals of care (GOC), and inpatient deaths. Outcomes associated with low- (≥ 21) versus high-risk (< 21) MASCC scores are presented as absolute differences. Results Of 193 patients, few (2%, n = 3) had MASCC scores documented, but when calculated, 52% (n = 101) had a high-risk score (< 21). GOC were discussed in 12% (n = 24) of patients. Twenty one percent (n = 40) required intermediate/ICU level of care, and 12% (n = 23) died in the hospital. Those with a low-risk score were 33% less likely to require intermediate/ICU care (95% CI 23 to 44%) and 19% less likely to die in the hospital (95% CI 10% to 27%) compared to those with high-risk score. Conclusions MASCC score was rarely used for hospitalized patients with FN, but high-risk score was associated with worse outcomes. Education efforts to incorporate MASCC score into the workflow may help identify patients at high risk for complications and help clinicians admit these patients to a higher level of care (e.g., intermediate/ICU care) or guide them to initiate earlier GOC discussions.
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Affiliation(s)
- Prarthna V. Bhardwaj
- Division of Hematology Oncology, University of Massachusetts Medical School-Baystate, 759 Chestnut St, Springfield, MA 01199 USA
| | - Megan Emmich
- Division of Hematology Oncology, University of Connecticut, Farmington, CT USA
| | - Alexander Knee
- Office of Research, Epidemiology/Biostatistics Research Core, Baystate Medical Center, Springfield, MA USA
| | - Fatima Ali
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA USA
| | - Ritika Walia
- Department of Medicine-Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA USA
| | | | - Jackson Clark
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA USA
| | - Arthi Sridhar
- Division of Hematology Oncology, University of Texas at Houston, Houston, TX USA
| | - Tara Lagu
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern Feinberg School of Medicine, Chicago, IL USA
- Division of Hospital Medicine, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - Kah Poh Loh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY USA
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Wanitpongpun C, Teawtrakul N, Lanamtieng T, Chansung K, Sirijeerachai C, Amampai W, Sawanyawisuth K. Clinical factors predictive of mortality in acute leukemia patients with febrile neutropenia. AMERICAN JOURNAL OF BLOOD RESEARCH 2021; 11:59-65. [PMID: 33796390 PMCID: PMC8010598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Acute leukemia is mainly treated with chemotherapy leading to febrile neutropenia (FN). There is limited data on clinical factors predictive of mortality in adults with acute leukemia and FN. METHODS This was a retrospective cohort study and enrolled adult patients, diagnosed as acute leukemia, and developed FN. The eligible patients were admitted and followed up with mortality as the primary outcome. A stepwise, multivariate logistic regression analysis was used to find predictors for mortality. RESULTS There were 203 patients met the study criteria. Of those, 14 patients died (6.89%). AML was the most common type of acute leukemia with FN (64.04%). There were five remaining factors in the final model: AML, FN at admission, prolong broad spectrum antibiotics, lower respiratory tract infection, and Aspergillosis. Only lower respiratory tract infection was significant with adjusted odds ratio of 7.794 (95% CI of 1.549, 39.212). The Hosmer-Lemeshow Chi square was 2.74 (p value 0.907). The lower respiratory tract infection group had higher proportions of Gram negative and fungus than the non-lower respiratory tract infection group; specifically E. coli (p 0.003), and Aspergillus (P < 0.001). CONCLUSIONS There were two independent predictors of mortality in acute leukemia patients with FN: septic shock and lower respiratory tract infection regardless of leukemia type or pathogen. E. coli and Aspergillus were more common in those with lower respiratory tract infection than those without. No specific pathogens were found in cases of septic shock.
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Affiliation(s)
- Chinadol Wanitpongpun
- Department of Medicine, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand
| | - Nattiya Teawtrakul
- Department of Medicine, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand
| | - Theerin Lanamtieng
- Department of Medicine, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand
| | - Kanchana Chansung
- Department of Medicine, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand
| | | | - Worakamol Amampai
- Department of Medicine, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand
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Ba Y, Shi Y, Jiang W, Feng J, Cheng Y, Xiao L, Zhang Q, Qiu W, Xu B, Xu R, Shen B, Luo Z, Xie X, Chang J, Wang M, Li Y, Shuang Y, Niu Z, Liu B, Zhang J, Zhang L, Yao H, Xie C, Huang H, Liao W, Chen G, Zhang X, An H, Deng Y, Gong P, Xiong J, Yao Q, An X, Chen C, Shi Y, Wang J, Wang X, Wang Z, Xing P, Yang S, Zhou C. Current management of chemotherapy-induced neutropenia in adults: key points and new challenges: Committee of Neoplastic Supportive-Care (CONS), China Anti-Cancer Association Committee of Clinical Chemotherapy, China Anti-Cancer Association. Cancer Biol Med 2020; 17:896-909. [PMID: 33299642 PMCID: PMC7721096 DOI: 10.20892/j.issn.2095-3941.2020.0069] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/23/2020] [Indexed: 12/31/2022] Open
Abstract
Chemotherapy-induced neutropenia (CIN) is a potentially fatal and common complication in myelosuppressive chemotherapy. The timing and grade of CIN may play prognostic and predictive roles in cancer therapy. CIN is associated with older age, poor functional and nutritional status, the presence of significant comorbidities, the type of cancer, previous chemotherapy cycles, the stage of the disease, specific chemotherapy regimens, and combined therapies. There are many key points and new challenges in the management of CIN in adults including: (1) Genetic risk factors to evaluate the patient's risk for CIN remain unclear. However, these risk factors urgently need to be identified. (2) Febrile neutropenia (FN) remains one of the most common reasons for oncological emergency. No consensus nomogram for FN risk assessment has been established. (3) Different assessment tools [e.g., Multinational Association for Supportive Care in Cancer (MASCC), the Clinical Index of Stable Febrile Neutropenia (CISNE) score model, and other tools] have been suggested to help stratify the risk of complications in patients with FN. However, current tools have limitations. The CISNE score model is useful to support decision-making, especially for patients with stable FN. (4) There are still some challenges, including the benefits of granulocyte colony stimulating factor treatment and the optimal antibiotic regimen in emergency management of FN. In view of the current reports, our group discusses the key points, new challenges, and management of CIN.
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Affiliation(s)
- Yi Ba
- Department of Gastrointestinal Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenqi Jiang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jifeng Feng
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Ying Cheng
- Department of Oncology, Jilin Province Cancer Hospital, Changchun 130012, China
| | - Li Xiao
- Department of Oncology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361004, China
| | - Qingyuan Zhang
- Department of Oncology, Cancer Hospital Harbin Medical University, Harbin 150081, China
| | - Wensheng Qiu
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ruihua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Bo Shen
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaodong Xie
- Department of Oncology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Jianhua Chang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Mengzhao Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Yufu Li
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Yuerong Shuang
- Lymphoma and Myeloma Department, Jiangxi Cancer Hospital, Nanchang 330029, China
| | - Zuoxing Niu
- Department of Medical Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Bo Liu
- Department of Medical Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Herui Yao
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430070, China
| | - Huiqiang Huang
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Gongyan Chen
- Department of Oncology, Cancer Hospital Harbin Medical University, Harbin 150081, China
| | - Xiaotian Zhang
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hanxiang An
- Department of Medical Oncology, Xiang'an Hospital of Xiamen University, Xiamen 361101, China
| | - Yanhong Deng
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Ping Gong
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi 832000, China
| | - Jianping Xiong
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qinghua Yao
- Department of Integrated Chinese and Western Medicine, Cancer Hospital of University of Chinese Academy of Science, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Xin An
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Cheng Chen
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Yanxia Shi
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jialei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaohua Wang
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Zhiqiang Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Puyuan Xing
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chenfei Zhou
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Uchida M, Yamaguchi Y, Hosomi S, Ikesue H, Mori Y, Maegawa N, Takano A, Sato Y, Hosohata K, Muroi N, Tomii K, Hashida T, Nakamura T. Risk Factors for Febrile Neutropenia Induced by Docetaxel Chemotherapy in Patients with Non-small Cell Lung Cancer. Biol Pharm Bull 2020; 43:1235-1240. [PMID: 32435013 DOI: 10.1248/bpb.b20-00266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We retrospectively obtained data of patient background and pretreatment characteristics from medical records and identified the predictive factors of febrile neutropenia (FN) in patients with non-small cell lung cancer (NSCLC) treated with docetaxel alone or in combination with the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab. Patients were eligible for inclusion in the study if they were 20 years or older, diagnosed with NSCLC, and received docetaxel monotherapy alone or in combination with bevacizumab at the Department of Respiratory Medicine, Kobe City Medical Center General Hospital, between July 1, 2011, and March 31, 2018. Eighty-one patients with recurrent or advanced NSCLC were included. Multivariate stepwise logistic regression analysis with backward selection revealed that lower baseline Eastern Cooperative Oncology Group performance status (ECOG-PS) scores of 1 and 2 (odds ratio (OR), 5.098; 95% confidence interval (CI), 1.045-24.879, p = 0.021) and baseline platelet count below 18.8 × 104/µL (OR, 3.861; 95% CI, 1.211-12.311, p = 0.022) were significant factors influencing the FN occurrence rate. Our results demonstrated that ECOG-PS 1-2 and lower baseline platelet count were significant risk factors of FN in patients with NSCLC receiving docetaxel-based chemotherapy. Moreover, the combination of anti-VEGF antibodies and docetaxel might be associated with increased FN frequency. Despite the limitations of this study including its retrospective design, single-center site, and small sample size, baseline ECOG-PS score and platelet count may be regarded as important indices to identify patients for prophylactic granulocyte-colony stimulating factor (G-CSF) treatment before docetaxel-based chemotherapy.
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Affiliation(s)
- Mayako Uchida
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Yuki Yamaguchi
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Syuhei Hosomi
- Department of Pharmacy, Kobe City Medical Center General Hospital
| | - Hiroaki Ikesue
- Department of Pharmacy, Kobe City Medical Center General Hospital
| | - Yasuhiro Mori
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Nami Maegawa
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Aoi Takano
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital
| | - Keiko Hosohata
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Nobuyuki Muroi
- Department of Pharmacy, Kobe City Medical Center General Hospital
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital
| | - Tohru Hashida
- Department of Pharmacy, Kobe City Medical Center General Hospital
| | - Tsutomu Nakamura
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences
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Zheng B, Toarta C, Cheng W, Taljaard M, Reaume N, Perry JJ. Accuracy of the Multinational Association of Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores for predicting serious complications in adult patients with febrile neutropenia: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 149:102922. [DOI: 10.1016/j.critrevonc.2020.102922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/27/2019] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
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7
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Du X, Min J, Shah CP, Bishnoi R, Hogan WR, Lemas DJ. Predicting in-hospital mortality of patients with febrile neutropenia using machine learning models. Int J Med Inform 2020; 139:104140. [PMID: 32325370 DOI: 10.1016/j.ijmedinf.2020.104140] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/12/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Febrile neutropenia (FN) has been associated with high mortality among adults with cancer. Current systems for early detection of inpatient FN mortality are based on scoring indexes that require intensive physicians' subjective evaluation. OBJECTIVE In this study, we leveraged machine learning techniques to build a FN mortality risk evaluation tool focused on FN admissions without physicians' subjective evaluation. METHODS We used the National Inpatient Sample and Nationwide Inpatient Sample (NIS) that included mortality data among adult inpatients who were diagnosed with FN during a hospital admission. Machine learning techniques that we compared included linear models (ridge logistic regression and linear support vector machine) and non-linear models (gradient boosting tree and neural network). The primary outcome for this study was death among individuals with a recorded FN admission. Model comparison was evaluated based on areas under the receiver operating characteristic curve (AUROC) and model performance was estimated using 30 % test set created via stratified split. RESULTS Our analysis detected 126,013 adult admissions within the NIS data that were diagnosed with FN, among which 5,856 were declared as deceased (4.6 %). Our machine learning results demonstrate linear models and non-linear models achieved areas under the receiver operating characteristic (AUROC) around 92 % in survival prediction. CONCLUSIONS We developed machine learning models that do not require physicians' subjective evaluation for FN mortality risk prediction.
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Affiliation(s)
- Xinsong Du
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jae Min
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Chintan P Shah
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Rohit Bishnoi
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Dominick J Lemas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States.
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Perčić I, Urošević I, Stokić E, Tomić Naglić D, Milošević I. Febrile neutropenia induces changes in insulin sensitivity similar to obesity. Acta Clin Belg 2019; 74:393-398. [PMID: 30332920 DOI: 10.1080/17843286.2018.1534577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background/aim: To determine insulin sensitivity before chemotherapy and during febrile neutropenia in patients with acute leukemia and to assess its effect on the number of documented infections, the severity of infection and the outcome of the first hospitalization. To compare insulin sensitivity in the study group to a group of patient with obesity. Materials and methods: The study group consisted of 30 (37% of the total number) patients with newly diagnosed acute leukemia. Testing of insulin sensitivity was done before chemotherapy and during febrile neutropenia. Parameters were compared to a group of 30 age, and sex matched patients with obesity. Results: Insulin sensitivity was normal before chemotherapy. Obese patients were characterized by insulin resistance. Febrile neutropenia led to the development of insulin resistance (t = -2.43, p = 0.021). The level of insulin resistance was in positive correlation with fibrinogen (r = 0.59, p < 0.05). Patients with a documented site of infection had higher fasting insulin and an insulin resistance before chemotherapy (t = -2.38, p = 0.024). Insulin sensitivity did not influence outcome of the first hospitalization. Conclusion: Patients with acute leukemia in febrile neutropenia developed changes in insulin sensitivity similar to those seen in obesity. Insulin resistance was present in patients with a documented site of infection, and it worsened with the extent of inflammation. The outcome of the first hospitalization was not affected.
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Affiliation(s)
- Ivanka Perčić
- Clinic of Hematology, Clinical Center Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Ivana Urošević
- Clinic of Hematology, Clinical Center Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Edita Stokić
- Clinic of Diabetes, Endocrinology and Metabolic Disorders, Clinical Center Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Dragana Tomić Naglić
- Clinic of Diabetes, Endocrinology and Metabolic Disorders, Clinical Center Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Ivana Milošević
- Clinic of Hematology, Clinical Center Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
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Jacquet J, Catala G, Machiels JP, Penaloza A. Neutropénie fébrile aux urgences, stratification du risque et conditions du retour à domicile. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La neutropénie fébrile (NF) est une situation fréquemment rencontrée aux urgences avec un taux de mortalité non négligeable variant de 5 à 40 %. Cette variabilité importante met en avant l’importance de stratifier le risque afin de permettre un traitement ambulatoire per os de certains patients à faible risque. En plus du MASCC (The Multinational Association for Supportive Care in Cancer) score, d’autres outils permettent d’évaluer ce risque ou sont à l’étude dans ce but, tels que le dosage de la CRP, la procalcitonine ou encore le score CISNE. Après une prise en charge rapide aux urgences incluant l’administration sans délai d’un traitement adéquat, la poursuite de l’antibiothérapie per os à domicile est envisageable chez les patients à faible risque. La combinaison amoxicilline–acide clavulanique et ciprofloxacine est le plus souvent recommandée, mais la moxifloxacine ou la lévofloxacine en monothérapie peuvent également être utilisées pour les patients traités à domicile. Le retour à domicile permet de réduire fortement les coûts engendrés par l’hospitalisation, de diminuer le risque d’infection nosocomiale et d’améliorer la qualité de vie des patients avec NF à faible risque. Dans cette optique, plusieurs critères doivent être remplis, et une discussion avec le patient reste primordiale à la prise de décision. Parmi ceux-ci, nous retiendrons notamment un score MASCC supérieur à 21, une durée attendue de neutropénie inférieure à sept jours, l’accord du patient et de son entourage ainsi que la proximité entre le domicile et un service de soin adapté.
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Lee M, Yee J, Kim JY, Kim JY, An SH, Lee KE, Gwak HS. Risk factors for neutropenia and febrile neutropenia following prophylactic pegfilgrastim. Asia Pac J Clin Oncol 2019; 15:231-237. [PMID: 30997742 DOI: 10.1111/ajco.13152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/25/2019] [Indexed: 01/26/2023]
Abstract
AIM Neutropenia is a common side effect of myelosuppressive chemotherapy. Administration of granulocyte colony-stimulating factor is being used for neutropenia prophylaxis, but there are patients who develop neutropenia or febrile neutropenia despite prophylaxis. We attempted to identify potential risk factors for chemotherapy-induced neutropenia in patients with pegfilgrastim prophylaxis. METHODS This was a single-center, retrospective, observational study of patients with breast cancer or diffuse large B-cell lymphoma. We obtained patients' data from electronic medical records, including baseline demographics and clinical characteristics regarding diseases, treatments and laboratory values. The outcome measures assessed were the incidence of neutropenia and febrile neutropenia. RESULTS There were a total of 127 patients, including 77 patients with diffuse large B-cell lymphoma (DLBCL) and 50 patients with breast cancer, and we analyzed 722 chemotherapy cycles. We found 88 cases (12.2%) of grade 3 or 4 neutropenia and 39 cases of febrile neutropenia (5.4%). In the univariate analysis, variables associated with both grade 3 or 4 neutropenia and febrile neutropenia were age, cancer type, cancer stage, radiotherapy and platelet count. A multivariate logistic regression model revealed that age, radiotherapy and platelet count were significant factors in severe neutropenia, whereas platelet count was the only statistically significant factor in febrile neutropenia. Platelet counts of less than 150 000/mm3 increased the risk of neutropenia and febrile neutropenia approximately fourfold. In the subgroup analysis of patients with DLBCL, it was found that platelet count was a significant factor for both neutropenia and febrile neutropenia. CONCLUSION Among cancer patients with pegfilgrastim prophylaxis, advanced age, absence of radiation therapy and low platelet count were independent predictors of neutropenia, and low platelet count was the predictor of febrile neutropenia.
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Affiliation(s)
- Mirinae Lee
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Asan Medical Center, Seoul, Korea
| | - Jeong Yee
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
| | - Jae Youn Kim
- Department of Pharmacy, Asan Medical Center, Seoul, Korea
| | - Ju Young Kim
- College of Pharmacy, Chungbuk National University, Cheongju-si, Korea
| | - Sook Hee An
- College of Pharmacy, Wonkwang University, Jeonbuk, Korea
| | - Kyung Eun Lee
- College of Pharmacy, Chungbuk National University, Cheongju-si, Korea
| | - Hye Sun Gwak
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
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11
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Casanovas Blanco M. Critical review of emergency department management of chemotherapy complications in cancer patients. Eur J Cancer Care (Engl) 2018; 28:e12974. [PMID: 30520179 DOI: 10.1111/ecc.12974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 07/10/2018] [Accepted: 10/21/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Recent worldwide advances in cancer therapies have resulted in an increased number of people receiving chemotherapy in ambulatory care settings. In Spain, emergency departments are the single point of entry to acute inpatient services and they play a pivotal role in the management of chemotherapy complications. Little research exists in patterns of emergency department utilisation by oncology patients with chemotherapy-related complications. However, it is important for the oncology patients and the healthcare system to gain understanding in the disease pathway and the organisational factors influencing the quality of care. METHODS This critical review's main aims were to describe the clinical characteristics of patients who presented to an emergency department after chemotherapy treatment as reported in international literature; to map reported patterns of care in emergency department access; and quality of care exploring the management of febrile neutropenic patients described in the literature, against best practice guidelines. RESULTS The search strategy yield 701 articles from MEDLINE, TROVE and SCOPUS and 26 were included. The review combines systematic reviews, observational, cross-sectional case-control studies and randomised control trials. CONCLUSION All articles showed areas and opportunities for improvement in the management of this population, especially with regard to time from triage to antibiotic administration in febrile neutropenic patients.
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12
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Spinardi JR, Berea R, Orioli PA, Gabriele MM, Navarini A, Marques MT, Neto MN, Mimica MJ. Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer. Germs 2017. [PMID: 28626736 DOI: 10.18683/germs.2017.1110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Febrile neutropenia is one of the most serious treatment-related complications in cancer patients. Susceptible to rapidly progressing infections, which result in prolonged hospitalization and use of broad-spectrum antibiotics, neutropenic patients are subject to colonization by multiresistant agents, which enhances the risk of infections. METHODS In this study we included samples collected with nasal, oropharyngeal and anal swabs from hospitalized children with febrile neutropenia following chemotherapy, between March 2014 and 2015, aiming to elucidate colonization by S. aureus and Enterococcus spp., as well as their resistance profile. RESULTS S. aureus was found in 22% of the patients and 14% of the events. Methicillin-resistant S. aureus colonized 13.6% of patients. Including anal swabs in the screening increased the identification of colonized patients by 20%. Enterococcus spp. was found in 27% of patients and 17% of episodes. Enterococcal isolates resistant to vancomycin, accounting for 25% of the total, were not isolated in anal swabs at any time, with the oropharyngeal site being much more important. The rate of infection by Enterococcus spp. was 4.5% of all patients and 16% among the colonized patients. CONCLUSION Especially in this population, colonization studies including more sites can yield a higher chance of positive results. Establishing the colonization profile in febrile neutropenic children following chemotherapy may help to institute an empirical antibiotic treatment aimed at antibiotic adequacy and lower induction of resistance, thereby decreasing the risk of an unfavorable clinical outcome.
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Affiliation(s)
- Julia R Spinardi
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Rodrigo Berea
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Patricia A Orioli
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Marina M Gabriele
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Alessandra Navarini
- PhD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Marina T Marques
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Milton N Neto
- MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
| | - Marcelo J Mimica
- MD, PhD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil
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Yapici O, Gunseren F, Yapici H, Merdin A, Yaylali ÜÜ, Merdin FA. Evaluation of febrile neutropenic episodes in adult patients with solid tumors. Mol Clin Oncol 2015; 4:379-382. [PMID: 26998287 PMCID: PMC4774564 DOI: 10.3892/mco.2015.722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/07/2015] [Indexed: 11/06/2022] Open
Abstract
The clinical use of cytotoxic chemotherapeutic agents has increased survival in cancer patients. However, treatment-associated bone marrow suppression and neutropenia often render patients prone to life-threatening infections. The aim of this study was to evaluate episodes of febrile neutropenia (FN) in patients with solid tumors, and identify the microorganisms and the factors affecting mortality. A total of 100 primary febrile attacks in cancer patients who were followed up at the Department of Oncology of the Akdeniz University Medical Faculty Hospital between January, 2011 and May, 2012, were retrospectively investigated. FN attacks were classified in three groups as follows: Fever of unknown origin, clinically documented infections and microbiologically documented infections. We found that prolonged neutropenia, Multinational Association for Supportive Care in Cancer (MASCC) score <21 and the presence of metastasis increased mortality. We also compared the three groups of infection categories according to mortality rate, but did not observe any significant differences among these groups. Patients with malignancies should be assessed individually during the FN episodes. It is crucial to keep possible infectious pathogens in mind and evaluate the MASCC score, neutropenia duration and metastatic status of the patients, and start empirical antibiotic therapy immediately.
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Affiliation(s)
- Oktay Yapici
- Department of Infectiology and Microbiology, Akdeniz University Hospital, Antalya 07059, Turkey
| | - Filiz Gunseren
- Department of Infectiology and Microbiology, Akdeniz University Hospital, Antalya 07059, Turkey
| | - Hafize Yapici
- Department of Infectiology and Microbiology, Akdeniz University Hospital, Antalya 07059, Turkey
| | - Alparslan Merdin
- Department of Internal Medicine, Akdeniz University Hospital, Antalya 07059, Turkey
| | - Ülkü Üser Yaylali
- Department of Infectiology and Microbiology, Akdeniz University Hospital, Antalya 07059, Turkey
| | - Fatma Avci Merdin
- Department of Internal Medicine, Akdeniz University Hospital, Antalya 07059, Turkey
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