1224. Predictive Value of Rothman Index in Patients that Develop Febrile Neutropenia
Session: Poster Abstract Session: Transplant Screenings and Evaluation and Empiric and Pre-Emptive Therapy
Friday, October 9, 2015
Room: Poster Hall
Background: Febrile Neutropenia (FN) in cancer patients is associated with a high mortality rate yet identifying patients with FN at highest risk for short term morbidity and mortality remains challenging. The Rothman Index (RI) is a real-time composite measurement of a patient’s condition using 26 clinical variables sensitive to signs of patient clinical decline. RI has been shown to predict intensive care unit admission, hospital readmission and short term mortality among inpatients.  The aim of this study was to determine if RI at onset of FN is associated with inpatient mortality or discharge to hospice care.

Methods: A retrospective analysis of adult Oncology inpatients with FN was performed.  Clinical variables collected included demographics, malignancy type, comorbidities, admission condition and microbiological data related to the FN episode. The primary outcome measure was in-hospital mortality or discharge to hospice care.  Variables associated with the primary outcome in univariate analysis were entered into a multivariate logistic regression model for analysis.

Results: Of 411 patients included 308 (74.9%) had hematological malignancies, 259 (63.0%) had FN at admission and 48 (11.7%) died or were discharged to hospice.  Controlling for malignancy type, major medical comorbidities and microbiologically confirmed bacterial infection, RI < 70 was independently associated with this outcome.  Baseline renal disease, pneumonia, respiratory failure and sepsis were also associated with the primary outcome.

Conclusion: RI is an objective measure that can predict poor outcomes among inpatients with FN.  RI can guide clinicians caring for patients with FN in both prognostication and identifying patients at high risk for mortality which can guide inpatient care.  The utility of this scoring system should be compared to existing risk stratification systems used in Oncology to identify its optimal use in the clinical setting.

Table. Factors associated with inpatient mortality or hospice discharge among Oncology inpatients with febrile neutropenia

Variable

OR

95% CI for OR

p

RI < 70

3.78

1.36-10.50

.011

Respiratory Failure

5.47

2.01-14.46

.001

Renal Disease

4.32

1.40-12.79

.011

Sepsis

6.13

1.48-25.45

.013

Pneumonia

7.69

1.60-36.89

.011


Luis Rubio, B.S., Yale University School of Medicine, New Haven, CT, Alfred Lee, M.D., Ph.D., Medicine, Section of Hematology, Yale Cancer Center/Yale University School of Medicine, New Haven, CT and David Banach, M.D., M.P.H., M.S., Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT

Disclosures:

L. Rubio, None

A. Lee, None

D. Banach, None

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