Patient selection: solid or hematologic (leukemia, lymphoma) cancer
Criteria: fever (oral temperature >= 38.0°C) and neutropenia (absolute neutrophil count < 500 per µL)
Patient groups:
(1) inpatient at onset of fever and neutropenia
(2) outpatient with significant comorbidity requiring hospital admission
(3) outpatient with uncontrolled cancer
(4) outpatient without significant comorbidity or uncontrolled cancer
Significant comorbidities included:
(1) hypotension
(2) altered mental status
(3) respiratory failure
(4) herpes zoster
(5) clinical bleeding with severe thrombocytopenia or severe anemia
(6) deep vein thrombosis
(7) carcinomatous meningitis
(8) spontaneous pneumothorax
(9) spinal cord compression
(10) gross hematuria with urinary tract obstruction
(11) severe hypertension
(12) cavitary lung nodule
(13) presyncope
(14) dehydration and/or pain
(15) decubital ulcer
|
Group
|
Major Complications
|
Mortality
|
|
1
|
35%
|
16%
|
|
2
|
47%
|
16%
|
|
3
|
31%
|
13%
|
|
4
|
2%
|
0%
|
Major complications included:
(1) severe hypotension
(2) respiratory failure
(3) cardiac dysrhythmia or ECG change
(4) altered mental status
(5) focal neurologic abnormality lasting >= 24 hours
(6) congestive heart failure
(7) hemorrhage requiring transfusion with multiple units of blood
(8) severe abdominal pain
(9) aseptic meningitis
(10) lung lobe collapse
(11) veno-occlusive disease
(12) airway obstruction
(13) cardiac tamponade
(14) typhilitis
(15) opportunistic fungal infection
(16) sepsis
(17) DIC
