Prognostic factors for mortality with febrile neutropenia in hospitalized patients

Abstract

Background: Febrile neutropenia is a life-threatening complication of cancer treatment that results in hospitalization and delays cancer therapy. The aim of this study is to identify prognostic factors of patients admitted with febrile neutropenia. Methods: A retrospective study via chart review without direct patient contact was conducted. All adults above 18 years with the diagnosis of febrile neutropenia hospitalized in University Medical Center in Lubbock, Texas, between January 2010 and December 2013 were reviewed. The data were analyzed with IBM SPSS statistics. Results: One hundred twenty-seven patients were included in this study. The hospital mortality rate was 17.3%, and the 30-day mortality rate was 20.5%. The median length of stay (LOS) was eight days. Hematologic malignancies accounted for 66.1% of the patients. On multivariate analysis, the in-hospital mortality rate was associated with fever duration (adjusted odds ratio [OR] 7.19; 95% CI 1.06-50.00; p <0.04), abnormal liver function tests (adjusted OR 63.72; 95% CI 5.95-682.07; p <0.001), ICU admission (OR 45.78; 95% CI 4.97-420.99; p <0.001) and positive culture (adjusted OR 12.71; 95% CI 1.14-142; p <0.039). The independent risk factors for a 30-day mortality rate were abnormal liver enzymes (OR 48.38; 95% CI 5.27-444.29; p <0.001), ICU admission (OR 63.66; 95% CI 5.96-680.30; p <0.001) and fever duration more than four days (OR 8.26; 95% CI 1.11-62.50; p=0.039). The data indicated that diagnosis of hematologic malignancies (OR 4.06; 95% CI 1.34-12.31 p=0.013), fever duration (adjusted OR 6.29; 95% CI 1.81-21.92; p 0.004) and neutropenic duration more than five days (OR 3.68; 95% CI 1.44-9.40 p=0.007) were associated with LOS more than eight days. Conclusions: Febrile neutropenia in hospitalized patients results in a significant mortality rate. Factors associated with increased mortality include ICU admission and abnormal liver enzyme tests.