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Original ArticleOpen Access
Risk Index for Predicting Complications and Prognosis in Thai Patients with Neutropenia and Fever
Chayakulkeeree M 
,
Thamlikitkul V
,
Thamlikitkul V ME THEE CHA Y AKULKEEREE, MD*,
VISANU THAMLIKITKUL, MD*
Background
: New strategies in the treatment of febrile neutropenic patients have been pro-
posed during the past decade. It is more and more widely accepted that febrile neutropenic patients
are a heterogeneous population and they have varying risks for complications and death. However,
most of the data have been collected from patients in Western countries. The purpose of the study was
to identify types of infection and etiologic organisms in febrile neutropenic patients at Siriraj Hos-
pital, Thailand, and also to develop a prediction model in order to identify patients who are expected
to have a favorable outcome or a low-risk subset.
Method
: The medical records of chemotherapy-induced neutropenic patients with fever
hospitalized at Siriraj Hospital. Thailand, from January 1999 to December 2000 were analyzed. Data
included patient characteristics, epidemiological data and the potential factors at the onset of fever
for predicting patient outcome. A scoring system for predicting patients with favorable outcome was
developed. The scoring system developed from this study was compared with a previously used scoring
system.
Results
: Of 220 patients with 267 febrile neutropenic episodes, 71.8 per cent had hemato-
logic malignancies and 28.2 per cent had solid tumors. Bacteremia was found in 61 episodes (22.8%)
and gram negative bacilli were the most common causative organism in bacteremia (88.6%). Overall
mortality was 17.7 per cent. Multivariate analysis revealed that the factors predicting outcome were
burden of illness, control of cancer, duration of neutropenia and dehydration. The scoring system
developed from this set of data revealed that a
score~
16 identified patients with a favorable outcome
with a specificity of 90.2 per cent, sensitivity of 76.6 per cent and positive predictive value of 85.4
per cent.
Vol. 86 No.3
RISK INDEX AND PROGNOSIS IN FEBRILE NEUTROPENIA
213
Conclusion : The causative organisms of bacterial infections in febrile neutropenic patients
in Thailand are still gram negative bacteria. The locally developed risk index has a fair accuracy to
identify patients with favorable outcome and may be used to identify patients suitable for less aggres-
sive treatment strategies.
Key word : Agranulocytosis, Neutropenia, Febrile Neutropenia, Prognosis
VISANU THAMLIKITKUL, MD*
Background
: New strategies in the treatment of febrile neutropenic patients have been pro-
posed during the past decade. It is more and more widely accepted that febrile neutropenic patients
are a heterogeneous population and they have varying risks for complications and death. However,
most of the data have been collected from patients in Western countries. The purpose of the study was
to identify types of infection and etiologic organisms in febrile neutropenic patients at Siriraj Hos-
pital, Thailand, and also to develop a prediction model in order to identify patients who are expected
to have a favorable outcome or a low-risk subset.
Method
: The medical records of chemotherapy-induced neutropenic patients with fever
hospitalized at Siriraj Hospital. Thailand, from January 1999 to December 2000 were analyzed. Data
included patient characteristics, epidemiological data and the potential factors at the onset of fever
for predicting patient outcome. A scoring system for predicting patients with favorable outcome was
developed. The scoring system developed from this study was compared with a previously used scoring
system.
Results
: Of 220 patients with 267 febrile neutropenic episodes, 71.8 per cent had hemato-
logic malignancies and 28.2 per cent had solid tumors. Bacteremia was found in 61 episodes (22.8%)
and gram negative bacilli were the most common causative organism in bacteremia (88.6%). Overall
mortality was 17.7 per cent. Multivariate analysis revealed that the factors predicting outcome were
burden of illness, control of cancer, duration of neutropenia and dehydration. The scoring system
developed from this set of data revealed that a
score~
16 identified patients with a favorable outcome
with a specificity of 90.2 per cent, sensitivity of 76.6 per cent and positive predictive value of 85.4
per cent.
Vol. 86 No.3
RISK INDEX AND PROGNOSIS IN FEBRILE NEUTROPENIA
213
Conclusion : The causative organisms of bacterial infections in febrile neutropenic patients
in Thailand are still gram negative bacteria. The locally developed risk index has a fair accuracy to
identify patients with favorable outcome and may be used to identify patients suitable for less aggres-
sive treatment strategies.
Key word : Agranulocytosis, Neutropenia, Febrile Neutropenia, Prognosis
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