Factors Influencing In-hospital Length of Stay and Mortality in Cancer Patients Suffering from Febrile Neutropenia


Introduction: Febrile neutropenia (FN) is a major complication of chemotherapy, costly in terms of morbidity,mortality and associated financial expenditure. The present study was conducted with the goal of highlightingFN as a serious problem in Pakistan, with the longer term objective of improved cancer survival, reduction inlength of stay (LOS) in hospital, morbidity, mortality and costs in our existing developing country scenario.
Methods: A cross-sectional descriptive study was conducted on patients, ≥18 years, admitted with FN as aconsequence of chemotherapy at a referral hospital in Karachi from 1st September 2006 to 30th April 2007.
Results: A total of 80 patients [43 (53.8%) males and 37 (46.2%) females] were selected. The mean age was 47.4(SD ±16.6; range 18-79) years. Sixty eight patients (86%) were ≤ 65 years, 50% were ≤ 50 years. Overall, inhospitalmortality was 11%; 4% for patients on granulocyte colony stimulating factor (G-CSF) prophylaxis asagainst 20% for those without. The cause of death was either pneumonia or septic shock. Mean LOS was 7.53(SD ±3.8; range 2-17) days. Hematological malignancies, older age, severity of dehydration, pneumonia andculture positivity were significantly associated with LOS and death. Those above 50 years of age were 1.5 timesas likely to be hospitalized longer and > three times as likely to die. Bacteremia conferred a 5-fold and pneumoniaan 8-fold increase in the risk of death.
Conclusion: The results of this study indicate that age, vital instability,dehydration, high creatinine, culture positivity and hematological malignancies are high risk factors inchemotherapy induced FN. Identification of FN risk factors with poor outcomes may help in devising protocolsfor modified dosage or including GCFs initially. This may help reduce the cost of cancer care as well as mortalityand morbidity. Prospective studies of FN in multiple centers in Pakistan may be beneficial in evaluating theserisk factors further.