Risk factors analysis and risk prediction of severe adverse events in solid cancer patients with febrile neutropenia

Abstract:

Objective To analyze the risk factors of serious adverse events（SAE）in solid cancer patients with febrile neutropenia（FN），and to compare the predictive efficacy of the clinical index of stable febrile neutropenia（CISNE） and the risk stratification model of Multinational Association of Supportive Care in Cancer（MASCC）.Methods The clinical data of solid cancer patients with FN after chemotherapy from January 2016 to June 2021 in Chongqing University Cancer Hospital were retrospectively collected. The patients were divided into the SAE group and the non-SAE group. The definition of SAE was as follows：①septic shock or other organ failure and necessary transfer to ICU during FN treatment；②or death within 60 days after FN. The clinical data of the two groups were compared，the binary logistic regression analysis was performed to obtain the independent risk factors of SAE，and the patients' CISNE and MASCC scores were calculated to compare the efficacy of CISNE and MASCC scores in identifying low-risk FN.Results A total of 91 patients were enrolled，including 18（19.78%）patients with SAE. The binary logistic regression analysis showed that the independent risk factors of SAE were as follows： ECOG score≥2 points，serum potassium<3.5 mmol/L，procalcitonin（PCT）≥ 0.5 ng/mL，and monocyte count ≤ 0.02×10⁹/L（OR=8.619，11.358，30.612，11.202；95%CI=1.124-66.094，1.696-76.047，5.013-186.947，1.889-66.440，P<0.05）. There were statistical differences in CISNE and MASCC scores between the SAE group and the non-SAE group（P<0.05）. The incidences of SAE in patients with CISNE score=0 point（low risk）and MASCC score≥21 points（low risk） were significantly lower than those in the non-low risk group（P<0.05）. The sensitivity，specificity，positive and negative predictive values of CISNE score=0 point and MASCC score≥21 points for identifying low-risk FN were 21.9%，100.0%，100.0%，24.0% and 91.8%，38.9%，85.9%，53.8%，respectively.Conclusion ECOG score≥2 points，serum potassium<3.5 mmol/L，PCT≥0.5 ng/mL，and monocyte count ≤ 0.02×10⁹/L are independent risk factors of SAE in solid cancer patients with FN. CISNE score=0 point has higher specificity and positive predictive value than MASCC ≥21 points in predicting low-risk FN.