Clinical, laboratory, treatment profiles and outcome of neutropenic fever among high-risk hematologic patients in Tikur Anbessa Specialized Hospital 2019, Ethiopia.
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Date
2020-01
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Addis Abeba University
Abstract
Background
Patients with hematologic malignancy are at a higher risk to develop neutropenic fever. The febrile
neutropenia episodes are associated with increase in morbidity and mortality of these patients. Outcome
of each of the episodes of febrile neutropenia is associated with the clinical, laboratory, microbiological,
imaging for source of infection and antimicrobial and chemotherapy regimen the patients is taking.
Objectives
The purpose of this study was to assess the correlation of the clinical, laboratory and treatment profiles of
the patients with neutropenic fever and hematologic malignancy with all-cause mortality in 30 days of
diagnosis of the neutropenic fever episode at Tikur Anbessa Specialized Hospital.
Methods
A single center, cross sectional retrospective study was conducted in hematology and medical wards of
Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia for the year 2019. The clinical profiles with
history and presumed site of infection, treatment plans and outcome in 30 days of diagnosis of the NF
episode were retrieved from medical charts. Chest imaging results during the diagnosis of the febrile
neutropenia episode were taken from the Med Web intranet database of the institution. The microbiology
data for the specimens collected for culture was retrieved form the log book at the microbiology
department of the Hospital. The data was subjected to bivariate and multivariate analysis using SPSS Ver
26.
Results
A sample of 132 patients with hematologic malignancy and neutropenic fever episode in the year 2019
were assessed. The study revealed that among patients with febrile neutropenia male to female ratio was
13:10. The patients had ALL (43.2%) and AML (40.9%) as the common underlying diseases. Frequent
site of primary infection was chest focus (33%). More than half of the patients were on combination
therapy with Cefepime and Vancomycin (40.9%). The odds of dying in 30 days of diagnosis was 5.4
times higher in patients with Medical ICU admission [AOR= 5.4; 95% CI: 1.22 - 23.92] and 3.8 higher in
those with past history of febrile neutropenia [AOR= 3.8; 1.44 - 10.16].
Conclusion
The history of prior treatment for febrile neutropenia and medical ICU admission during the course of
treatment of febrile neutropenia of patients with hematologic malignancy predicted all-cause in hospital
mortality in 30 days.
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Keywords
Febrile neutropenia, hematology malignancy, all-cause mortality