| Neutropenia is the most common dose-limiting toxicity response of systemic cancer chemotherapy.Febrile neutropenia(FN)and infection are severe complications caused by neutropenia.Such complications often cause subsequent chemotherapy delays or dose reductions,which may reduce the efficiency of treatment and compromise the clinical outcomes.They may also increase treatment costs and reduce quality of life,even can cause death.A systematic review of the literature shows that age,performance status,nutritional status,chemotherapy dose intensity,low baseline blood cell counts and early lymphopenia after chemotherapy were associated with the risk of febrile neutropenia.Similarly,age,diagnosis of leukemia or lymphoma,high temperature or low blood pressure at admission,and i.v.site infection along with low blood cell counts and organ dysfunction were associated with serious medical complications of neutropenia,including bacteremia and death.The available risk model studies,however,had several limitations such as retrospective analyses of small study populations,frequent missing values and differences in the predictive factors considered.The domestic literature shows that there were some clinical analysis and treatment for neutropenia complicated with nosocomial infection,but less research on status of febrile neutropenia and risk factors.To explore the current distribution of febrile neutropenia and infection,we conducted case-control study to analyze the risk factors on febrile neutropenia and infection in patients with chemotherapy-induced neutropenia in order to offer scientific references for clinical treatment. Material and MethodsTwo hundred and fifty-six in-patients with chemotherapy-induced neutropenia were enrolled as study population in Zhejiang Cancer Hospital from Jan.to Jul.2007. One result of the neutropenia patients were compared between the FN group and non-FN group according to the febrile detecting standard of NCCN.The other result was compared between the infection group and non-infection group according to the Hospital Infection Diagnostic Standard,conducted by Chinese Ministry of Health, 2001.The investigators filled in self-designed questionnaires mainly based on searching medical records,and the doctors or patients were inquired if necessary.The investigation questions consist of 45 items including patient,disease and treatment characteristics,etc.The data were processed with software of Microsoft Excel 2000 and SPSS13.0 in personal computer after verified.The statistical methods were calculated by ratio and proportion for occurrence of disease,Kappa test for relationship between fever and infection.Factors under univariate analysis(Chi-square test),whose P values less than 0.15 were fitted according regression models of febrile neutropenia and infection by stepwise regression.ResultsWithin 256 neutropenia patients after chemotherapy,100 cases(39.06%)suffered from febrile neutropenia,and 42 cases(16.41%)experienced infection.The mortality was 0.78%(2/256).The average age of febrile neutropenia was 51.14 years with 52.00%female breast cancer patients.Fever commonly occurred on day 7 after chemotherapy.The temperature of febrile patients was 39.0±0.64℃(maximum 41.5℃).There were 52 cases with hyperpyrexia(39.1～41℃)and 1 case with ultrahyperpyrexia(＞41.0℃). All types of fever were irregular fever.The average duration of fever was 3 days. Fourteen percent of febrile patients(14.00%)didn't undergo antibacterial agents. Thirteen episodes(37.14%)had positive cultures in febrile patients. Analysis on risk factors of febrile neutropenia:8 factors(performance status, baseline lymphopenia,chemotherapy regimen,cycles of chemotherapy, gastrointestinal side effect and early lymphopenia after chemotherapy,time of neutropenia occurred and the depth of the absolute neutrophil count nadir),whose P values less than 0.15 under univariate analysis were evaluated statistically by non-conditional logistic regression models.Multivariate analysis showed that early lymphopenia(P＜0.005,OR=2.309)and the depth of the absolute neutrophil count nadir after chemotherapy(P＜0.05,OR=2.349)were significantly independent risk factors of febrile neutropenia.Infection with neutropenia occurred in female were more than male patients,and the average age was 51.45 years.Infection commonly occurred on day 7 after chemotherapy.The main sites of the infection were pharynx(42.86%),oral cavity (21.43%)and low respiratory tract(14.29%).The rate of positive cultures was 65.38%in infection patients.Candida albicans(52.63%),Pseudomonas aeruginosa (15.79%)and Escherichia coli(10.53%)were the predominant pathogens.Two cases with compound infection had died.Analysis on risk factors of infection with neutropenia:7 factors(lymphoma,BMI, baseline lymphopenia,cycles of chemotherapy,early lymphopenia alter chemotherapy, time of neutropenia occurred and the depth of the absolute neutrophil count nadir), whose P values less than 0.15 under univariate analysis were evaluated statistically by non-conditional logistic regression models.Multivariate analysis showed that early lymphopenia after chemotherapy(P＜0.05,OR=3.347),the depth of the absolute neutrophil count nadir(＜0.2×10~9/L)(P＜0.05,OR=2.537)and the first cycle of chemotherapy(P＜0.05,OR=2.135)were significantly risk factors of infection in neutropenia patients.The infection rate of febrile neutropenia was 39.00%and some fever patients hadn't been infected.The agreement test showed that the consistency rate was 0.75 between fever and infection(Kappa=0.414)with moderate agreement. ConclusionThe incidence rates of fever and infection in patients with chemotherapy-induced neutropenia are high in current,which were 39.06%and 16.41%,respectively.The low early lymphopenia after chemotherapy and the absolute neutrophil count nadir are risk factors of febrile neutropenia.The low early lymphopenia after chemotherapy,the absolute neutrophil count nadir and the first cycle of chemotherapy are risk factors of infection.Fever is consistency with infection which consistency rate is 0.75.
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