2005, Number 73
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ABSTRACTIntroduction: Febrile neutropenia is a common and serious complication of chemotherapy for cancer. In addition to severe and prolonged neutropenia, there are other factors related to the high risk of dying in an event of neutropenia.
Objective: Assess factors associated to the risk of dying between 2 groups of patients with leukemia, neutropenia and fever.
Material and methods: This is a retrospective case-control study where 100 events of neutropenia (neutrophil count ‹ 500/mm3) and fever were reviewed; 59 patients (controls) were discharged from the hospital and 41 (Cases) patients died. The medical charts of patients admitted diagnosed with acute leukemia, neutropenia and fever after chemotherapy were reviewed. We analyzed the related clinical, hematological and microbiological characteristics. The different risk factors were also assessed to estimate the risk of death present during admission. We employed T- Students, analysis uni & bivariated, and multiple regression analysis.
Results: The statistical significance of the risk factors assessed through odds ratio, those most closely associated to a higher probability of death are: mechanical ventilation, Gram negative bacilli bacteremia (especially by Pseudomonas aeruginosa), the presence of pneumonia, diarrhea, neutrophil count ‹ 100, leukocyte count ‹ 500 and low platelet count, systemic inflammatory response, as well as septic shock. No association was found between mortality and the empirical treatment schemes used at admission.
Conclusions: Serious infections such as sepsis, bacteremia, pneumonitis, severe mucositis, mucosal ulcers, vomiting, diarrhea, shock or compensated shock, dehydration, hypertension, respiratory failure or compromise or failure of an important organ are universally recognized as predictors of severe or serious infections. In our study, some of these predictors additionally showed statistical significance in their association with mortality, finding a certain similarity with other studies where bronchial pneumonia, sepsis syndrome and bacteremia have been shown to serve as predictors of co-morbidity.
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