Neutropenic sepsis: management and complications

Clarke, Rachel; Jenyon, Tom; Parsons, Victoria van Hamel; King, Andrew

doi:10.7861/clinmedicine.13-2-185

Cited by 23 publications

(10 citation statements)

References 20 publications

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“…CRP levels can reach very high levels in autoinflammatory diseases such as vasculitis and systemic juvenile idiopathic arthritis, while leukocyte count may be normal or only moderately elevated (29). Likewise, leukopenia instead of leukocytosis is sometimes seen in patients with sepsis or systemic lupus erythematosus (30,31). In autoimmune disease and immunodeficiency, higher erythrocyte sedimentation rates are seen with lower levels of CRP.…”

Section: Discussionmentioning

confidence: 99%

Role of FDG-PET/CT in children with fever of unknown origin

Pijl

Kwee

Legger

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose To determine the role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) in children with fever of unknown origin (FUO). Methods This retrospective single-center study included 110 children (0–18 years) with FUO who underwent FDG-PET/CT between 2010 and 2019. The diagnostic value of FDG-PET/CT for identifying cause of fever was calculated, treatment modifications after FDG-PET/CT were assessed, and logistic regression analyses were performed to identify clinical and biochemical factors associated with FDG-PET/CT outcome. Results In 53 out of 110 patients (48%), FDG-PET/CT identified a (true positive) cause of fever. Endocarditis (11%), systemic juvenile idiopathic arthritis (5%), and inflammatory bowel disorder (5%) were the most common causes of FUO. In 42 patients (38%), no cause of fever was found on FDG-PET/CT. In 58 out of 110 patients (53%), treatment modifications were made after FDG-PET/CT. FDG-PET/CT achieved a sensitivity of 85.5%, specificity of 79.2%, positive predictive value of 84.1%, and negative predictive value of 80.9%. On multivariate logistic regression, C-reactive protein was positively associated with finding a true positive focus of fever on FDG-PET/CT (OR = 1.01 (95% CI 1.00–1.02) per mg/L increase in CRP), while leukocyte count was negatively associated with finding a true positive focus of fever (OR = 0.91 (95% CI 0.85–0.97) per 109 leukocytes/L increase). Conclusion FDG-PET/CT is a valuable diagnostic tool in the evaluation of children with FUO, since it may detect a true underlying cause in almost half (48%) of all cases where none was found otherwise. It allows full-body evaluation in patients without disease-specific symptoms on one examination. CRP and leukocyte count were significantly associated with FDG-PET/CT results, which may contribute to a priori assessment on the outcome of FDG-PET/CT. Future research could be aimed at evaluating more patient-specific factors to prospectively estimate the added value of FDG-PET/CT in children with FUO.

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Section: Discussionmentioning

confidence: 99%

Role of FDG-PET/CT in children with fever of unknown origin

Pijl

Kwee

Legger

et al. 2020

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

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“…The onset of septic infection can be insidious, and the outcome may be fatal. An early diagnosis of sepsis is crucial in the prevention of serious complications, and it still remains a challenge for clinicians because of the lack of appropriate diagnostic methods [ 1 ]. By definition, demonstrating bacteremia requires blood cultures, but they are time-consuming and often give false-negative results or get microbial contamination [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Soluble CD14 as a Diagnostic and Prognostic Biomarker in Hematological Patients with Febrile Neutropenia

et al. 2017

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Objective Elevated levels of a cell surface glycoprotein, soluble cluster of differentiation 14 (sCD14), have been observed in patients with sepsis. Only scarce data are available on sCD14 in hematological patients with chemotherapy-induced febrile neutropenia. The study aim was to investigate sCD14 as an early biomarker in febrile neutropenia after intensive chemotherapy to detect a rapidly deteriorating clinical course early enough to avoid serious infectious complications. Patients and Methods This prospective study included 87 adult hematological patients at the start of febrile neutropenia after intensive chemotherapy for acute myeloid leukemia or after autologous stem cell transplantation. The study endpoints were septic shock, severe sepsis, and positive blood culture findings. sCD14 was analyzed from day 0 to day 2, and its prognostic capacity was compared to that of C-reactive protein and procalcitonin. Results Plasma level of sCD14 predicted the development of septic shock on day 1 (p = 0.001) and day 2 but not the development of severe sepsis or blood culture positivity in hematological patients with chemotherapy-induced febrile neutropenia. Conclusions Soluble CD14 did not predict an overall complicated course at the early stages of febrile neutropenia. However, it was helpful in predicting the progression of the clinical course of neutropenic fever to septic shock.

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“…Abemaciclib induced grade ≥3 neutropenia is commonly managed by drug suspension and dose reduction [ 17 ]. Therefore it is important to identify the cohort of patients at high risk of grade ≥3 neutropenia at baseline as it can progress to neutropenic sepsis [ 18 ]. Final multivariable analysis identified race, ECOGPS and pre-treatment white blood cell count as the most significant predictors associated with the development of abemaciclib induced grade ≥3 neutropenia.…”

Section: Discussionmentioning

confidence: 99%

Prediction of severe neutropenia and diarrhoea in breast cancer patients treated with abemaciclib

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Neutropenic sepsis: management and complications

Abstract: Rachel T Clarke, 1 academic foundation doctor; Tom Jenyon, 2 medical education fellow; Victoria van Hamel Parsons, 3 medical student; Andrew J King, 1 specialist registrar, haematology

Cited by 23 publications

References 20 publications

Role of FDG-PET/CT in children with fever of unknown origin

Role of FDG-PET/CT in children with fever of unknown origin

Soluble CD14 as a Diagnostic and Prognostic Biomarker in Hematological Patients with Febrile Neutropenia

Prediction of severe neutropenia and diarrhoea in breast cancer patients treated with abemaciclib

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