PURPOSE: The authors intended to determine the predictive factors of bacteraemia in low-risk febrile neutropenia (FN) classified by the Multinational Association for Supportive Care in Cancer Risk Index score. METHODS: FN episodes managed in an emergency department from June 2009 to May 2010 were included. Clinical and laboratory features including procalcitonin (PCT) and C reactive protein (CRP) were retrospectively analysed. RESULTS: Of the total 285 episodes, 243 (85.3%) were classified as low risk. In this group, 19 (7.8%) had bacteraemia. There was a significant difference (p<0.05) in age, respiration rate ≥24 (36.8% vs 7.6%), Eastern Cooperative Oncology Group performance status (PS) ≥2 (42.1% vs 11.6%), platelet counts (107.0±42.4 vs 131.8±73.7 ×10(3)/mm(3)), serum aspartate aminotransferase (42.3±30.7 vs 28.7±17.4 IU/litre) and blood urea nitrogen (19.6±9.8 vs 11.6± 8.6 mg/dl) between episodes with and without bacteraemia. PCT ≥0.5 ng/ml and CRP ≥10 mg/dl had higher rates of bacteraemia than PCT <0.5 ng/ml (28.2% vs 3.9%, p<0.001) and CRP <10 mg/dl (13.9% vs 5.3%, p=0.022) did. On multivariate analysis, PCT ≥0.5 ng/ml (OR 4.7, 95% CI 1.38 to 16.29), respiration rate ≥24 (OR 4.1, 95% CI 1.20 to 13.63) and Eastern Cooperative Oncology Group PS ≥2 (OR 3.2, 95% CI 1.02 to 10.10) were predictive of bacteraemia in the low-risk group. CONCLUSION: PCT, tachypnoea and PS were predictive of bacteraemia in the low-risk patients with FN. If the patient has high probability of bacteraemia, the patient could benefit from parenteral antibiotic treatment while awaiting the blood culture results.
PURPOSE: The authors intended to determine the predictive factors of bacteraemia in low-risk febrile neutropenia (FN) classified by the Multinational Association for Supportive Care in Cancer Risk Index score. METHODS: FN episodes managed in an emergency department from June 2009 to May 2010 were included. Clinical and laboratory features including procalcitonin (PCT) and C reactive protein (CRP) were retrospectively analysed. RESULTS: Of the total 285 episodes, 243 (85.3%) were classified as low risk. In this group, 19 (7.8%) had bacteraemia. There was a significant difference (p<0.05) in age, respiration rate ≥24 (36.8% vs 7.6%), Eastern Cooperative Oncology Group performance status (PS) ≥2 (42.1% vs 11.6%), platelet counts (107.0±42.4 vs 131.8±73.7 ×10(3)/mm(3)), serum aspartate aminotransferase (42.3±30.7 vs 28.7±17.4 IU/litre) and blood urea nitrogen (19.6±9.8 vs 11.6± 8.6 mg/dl) between episodes with and without bacteraemia. PCT ≥0.5 ng/ml and CRP ≥10 mg/dl had higher rates of bacteraemia than PCT <0.5 ng/ml (28.2% vs 3.9%, p<0.001) and CRP <10 mg/dl (13.9% vs 5.3%, p=0.022) did. On multivariate analysis, PCT ≥0.5 ng/ml (OR 4.7, 95% CI 1.38 to 16.29), respiration rate ≥24 (OR 4.1, 95% CI 1.20 to 13.63) and Eastern Cooperative Oncology Group PS ≥2 (OR 3.2, 95% CI 1.02 to 10.10) were predictive of bacteraemia in the low-risk group. CONCLUSION: PCT, tachypnoea and PS were predictive of bacteraemia in the low-risk patients with FN. If the patient has high probability of bacteraemia, the patient could benefit from parenteral antibiotic treatment while awaiting the blood culture results.