Chemotherapy Induced Neutropenic Fever Seen at Emergency Room: A Review of 102 Cases.

Febrile neutropenia (FN) is a major toxicity of chemotherapy in cancer patients requiring prompt medical measures. Although the FN is a situation of oncologic emergency, the diagnosis and treatment may vary among institutions, and how fast the patients are being treated often depends on competence of House Officers at Emergency Room (ER). There has been limited data regarding the clinical outcome of patients with FN who were brought to ER.

We evaluated the clinical manifestations, therapeutic outcomes, and risk factors of FN in a retrospective analysis of 102 adult patients who visited ER from January 1, 2006 to March 31, 2009. FN was defined as a body temperature >38°C and a neutrophil count >0.5 × 10⁹/L on the day of fever or the day after.

The ECOG performance status (PS) was 0 in 15 patients, 1 in 67, and 2 in 20. The patients had a mean age of 57 years (range, 25–84). Fifty four patients were male, 52 female. Underlying diagnosis was lymphoma in 30, and soid tumors other than lymphoma in 72. The mean ANC was 436.8/mm³ (range, 0–1000); 4 patients had an ANC of <10/mm³. Twenty-three patients (22.5%) died of complications related to FN. There was no statistical difference in therapeutic outcome between tumor types, i.e. lymphoma versus non-lymphoma (p=.521), PS (p=.438), sex (p=.099), depth of neutropenia (p=.162), or time intervals from visiting ER to starting antibiotic therapy (p=.414). Age was important prognostic factor in therapeutic outcome. The median age in fatal cases was 62 years where as that of non-fatal cases was 54 (p=.016). Bacteremia was documented in 19 patients among whom 10 (53%) died. Mortality was significantly higher in patients with blood culture proven bacteria than patients whose blood culture yielded no organism (p=.013).

Cases of FN seen at ER showed substantial mortality especially in elderly patients. Given the rising age in cancer diagnosis as well as therapeutic intervention, higher mortality rate associated with chemotherapy induced FN in elderly patients needs further study seeking the way to reduce the risk of death

No relevant conflicts of interest to declare.