Assessment of factors affecting timing of discharge in pediatric cancer patients with febrile neutropenia.
Febrile neutropenia is a common cause of hospital admissions among pediatric cancer patients. To optimize personalized approaches for hospitalization and antibiotic treatment, risk stratification has been proposed. This study aimed to explore the impact of clinical and laboratory parameters on risk stratification for patient discharge.
This prospective study included pediatric lymphoma and solid tumor patients who were hospitalized due to febrile neutropenia between June 2018 and June 2019. Patient characteristics, primary oncological diagnosis and disease status, comorbid conditions, time elapsed after the last course of chemotherapy, use of granulocyte-colony stimulating factor (G-CSF) prophylaxis, presence of port catheter, infection type, fever values/duration, physical examination findings, and duration of neutropenia were collected. Laboratory investigations including complete blood counts, acute phase reactants at the onset of the episode, culture results were also recorded.
The study examined 142 febrile neutropenic episodes from 88 consecutive patients. The median age of the study group was 6.8 years, with 19.3% of cases being lymphoma and 80.7% having solid tumors. The median hospital stay was 7 days. Factors associated with longer hospitalization periods included a lymphoma diagnosis, presence of comorbid conditions, bone marrow involvement, and febrile neutropenic period during hospitalization. Patients presenting with fever ≥ 39 °C at admission, poor general appearance, hypotension, prolonged capillary filling time, and severe infection signs had longer hospital stays. In febrile neutropenic episodes, absolute monocyte count ≤ 100 cells/mm3, platelet count ≤ 50,000/mm3, and prolonged neutropenia delayed discharge time. Patients with microbiologically defined infections, especially those with positive catheter cultures, also had delayed discharge.
The diagnosis of lymphoma, poor general condition at admission, presence of microbiologically defined infection, thrombocytopenia, delayed recovery of absolute neutrophil counts, and prolonged fever duration were significant factors in determining the treatment duration and predicting discharge time.
This prospective study included pediatric lymphoma and solid tumor patients who were hospitalized due to febrile neutropenia between June 2018 and June 2019. Patient characteristics, primary oncological diagnosis and disease status, comorbid conditions, time elapsed after the last course of chemotherapy, use of granulocyte-colony stimulating factor (G-CSF) prophylaxis, presence of port catheter, infection type, fever values/duration, physical examination findings, and duration of neutropenia were collected. Laboratory investigations including complete blood counts, acute phase reactants at the onset of the episode, culture results were also recorded.
The study examined 142 febrile neutropenic episodes from 88 consecutive patients. The median age of the study group was 6.8 years, with 19.3% of cases being lymphoma and 80.7% having solid tumors. The median hospital stay was 7 days. Factors associated with longer hospitalization periods included a lymphoma diagnosis, presence of comorbid conditions, bone marrow involvement, and febrile neutropenic period during hospitalization. Patients presenting with fever ≥ 39 °C at admission, poor general appearance, hypotension, prolonged capillary filling time, and severe infection signs had longer hospital stays. In febrile neutropenic episodes, absolute monocyte count ≤ 100 cells/mm3, platelet count ≤ 50,000/mm3, and prolonged neutropenia delayed discharge time. Patients with microbiologically defined infections, especially those with positive catheter cultures, also had delayed discharge.
The diagnosis of lymphoma, poor general condition at admission, presence of microbiologically defined infection, thrombocytopenia, delayed recovery of absolute neutrophil counts, and prolonged fever duration were significant factors in determining the treatment duration and predicting discharge time.
Authors
Üstün Üstün, Aydın Aydın, Kurucu Kurucu, Yalçın Yalçın, Varan Varan, Kutluk Kutluk
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