Predictors of Bacteremia in Cancer Patients with Febrile Neutropenia

ABSTRACT

PURPOSE: Febrile neutropenia (FN) still remains a life-threatening cancer treatment-related toxicity and may compromise further chemotherapy in individual cancer patients. In this study, we sought to determine predictors of bacteremia in cancer patients with FN at the time of their visiting the emergency department. METHODS: Between January 1, 2007 and December 31, 2008, 392 episodes of FN in 342 cancer patients were retrospectively reviewed. We assessed clinical and laboratory features, and MASCC risk-index scores at admission to the emergency department. Statistical analysis was done using SPSS ver. 11.0. RESULTS: Among a total of 392 episodes, 34 (8.7%) showed bacteremia. There was a significant difference between bacteremic episodes and non-bacteremic episodes in tachycardia (56% vs. 31%), tachypnea (24% vs. 8%), high temperature (36% vs. 16%), hemoglobin (9.4 vs. 10.1 g/dL), platelet (73.3 vs. 117.5 x 10(3)/mm3), BUN (24 vs. 13 mg/dL), creatinine (1.2 vs. 0.8 mg/dL), and CRP (12.6 vs. 8.5 mg/dL). On multivariate analysis, low platelet count (OR 5.6, 95% CI 2.5-12.5, p<0.001), elevated BUN (OR 4.8, 95% CI 2.1-11.0, p<0.001), tachypnea (OR 3.2, 95% CI 1.2-8.3, p=0.020), and high temperature (OR 2.7, 95% CI 1.2-6.2, p=0.019) were independent factors associated with bacteremia. MASCC score < 21 was more frequent in bacteremic than non-bacteremic patients (32% vs. 10%, p=0.001). CONCLUSION: Low platelet count, elevated BUN, tachypnea, and high temperature are independent predictors of bacteremia in cancer patients with FN. Also, the MASCC risk-index score is a useful predictor of bacteremia.