Determination of the relationship between mortality and SOFA, qSOFA, MASCC scores in febrile neutropenic patients monitored in the intensive care unit
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Date
2021
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Abstract
Purpose: Febrile neutropenia (FN) is a hematological emergency. It is challenging and confusing for the clinicians to make the decision of the febrile neutropenic patients under chemotherapy to be monitored at intensive care unit (ICU). The aim of this study was to define the factors supporting decision-making for the critical patients with febrile neutropenia. Methods: The data of 60 patients, who were taken to the ICU while they were under treatment in the Hematology Clinic with a diagnosis of febrile neutropenia, were analyzed retrospectively, in order to identify clinically useful prognostic parameters. Results: The ICU mortality rate was 80%. Mortality was significantly associated with higher sequential organ failure assessment score (SOFA), quick sequential organ failure assessment score (qSOFA), and hematological SOFA (SOFAhem) scores on admission. All cases having SOFA score 10 and above and qSOFA score 2 and above died. In multivariate analysis, qSOFA score was found to be statistically significant in predicting mortality in regard to ICU admission (p = 0.004). Conclusion: Mortality of febrile neutropenic patients admitted to ICU is high. It would be appropriate to determine the extent of organ dysfunction instead of underlying disease, for making the decision of ICU admission. It should be noticed that the risk mortality is high for the FN cases with SOFA score 10 or above, qSOFA score 2 or above, and in need of mechanical ventilation and positive inotropic support; hence, early intervention is recommended. In our study, the most significant parameter in predicting ICU mortality was found to be qSOFA. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.
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Adolescent , Adult , Aged , Aged, 80 and over , Clinical Decision-Making , Critical Care , Emergency Service, Hospital , Febrile Neutropenia , Female , Hospital Mortality , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Monitoring, Physiologic , Organ Dysfunction Scores , Prognosis , Respiration, Artificial , Retrospective Studies , Sepsis , Young Adult , antineoplastic agent , dobutamine , dopamine , hypertensive factor , inotropic agent , noradrenalin , acute lymphoblastic leukemia , acute myeloid leukemia , adolescent , adult , aged , arterial pressure , Article , artificial ventilation , bone marrow biopsy , cancer chemotherapy , chronic lymphatic leukemia , controlled study , demography , disease association , febrile neutropenia , female , follow up , heart failure , hematologic malignancy , hospital admission , human , intensive care unit , invasive ventilation , length of stay , major clinical study , male , medical decision making , mortality , multinational association for supportive care in cancer , multiple myeloma , myeloproliferative disorder , retrospective study , scoring system , Sequential Organ Failure Assessment Score , sputum culture , clinical decision making , febrile neutropenia , hospital emergency service , hospital mortality , hospitalization , intensive care , intensive care unit , middle aged , organ dysfunction score , pathology , physiologic monitoring , procedures , prognosis , sepsis , very elderly , young adult