2352. Prediction of Febrile Neutropenia after Chemotherapy Based on Pre-treatment Risk Factors among Cancer Patients
Session: Poster Abstract Session: Transplant Infections - Epidemiology
Saturday, October 7, 2017
Room: Poster Hall CD
  • Theis Aagaard - IDweek 2017.pdf (419.1 kB)
  • Background: Febrile neutropenia (FN) is a common complication to chemotherapy associated with a high burden of morbidity and mortality. Reliable prediction of individual risk based on pre-treatment risk factors allows for stratification of preventive interventions. We aimed to develop such a risk stratification model to predict FN in the 30 days after initiation of chemotherapy.

    Methods: We included consecutive treatment-naïve patients with solid cancers and diffuse large B-cell lymphomas at Copenhagen University Hospital, 2010-2015. Data were obtained from the PERSIMUNE repository of electronic health records. FN was defined as neutrophils <= 0.5x10E9/L ​at the time of either a blood culture sample or death. Time from initiation of chemotherapy to FN was analysed using Fine-Gray models with death as a competing event. Risk factors investigated were: age, sex, body surface area, haemoglobin, albumin, neutrophil-to-lymphocyte ratio, Charlson Comorbidity Index (CCI) and chemotherapy drugs. Parameter estimates were scaled and summed to create the risk score. The scores were grouped into four: low, intermediate, high and very high risk.

    Results: Among 8,585 patients, 467 experienced FN, incidence rate/30 person-days 0.05 (95% CI, 0.05-0.06). Age (1 point if > 65 years), albumin (1 point if < 39 g/L), CCI (1 point if > 2) and chemotherapy (range -5 to 6 points/drug) predicted FN. Median score at inclusion was 2 points (range –5 to 9). The cumulative incidence and the incidence rates and hazard ratios of FN are shown in figure 1 and table 1, respectively.  

    Conclusion: We developed a risk score to predict FN the first month after initiation of chemotherapy. The score is easy to use and provides good differentiation of risk groups; the score needs independent validation before routine use.

    Table 1. Incidence rates and hazard ratios of developing FN
Risk group	N (%)	Risk score	Incidence rate/30 person-days (95% CI)	Hazard ratio
(95% CI)
Low	4,859 (57)	<3	0.02 (0.02-0.02)	Reference
Intermediate	1,881 (22)	3-4	0.07 (0.06-0.08)	3.4 (2.6-4.4)
High	1,747 (20)	5-7	0.14 (0.13-0.16)	7.2 (5.7-9.2)
Very high	98 (1)	8+	0.31 (0.21-0.45)	15.5 (9.9-24.3)

Figure 1. Cumulative incidence of febrile neutropenia with death as a competing risk. Shaded areas are pointwise 95% CI bands.

    Theis Aagaard, MD1, Ashley Roen, MA2, Gedske Daugaard, MD, DMSc, Professor3, Peter Brown, MD, PhD4, Henrik Sengeløv, MD5, Amanda Mocroft, MSc, Professor2, Jens Lundgren, MD, DMSc, Professor1 and Marie Helleberg, MD, PhD, DMSc1, (1)Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, (2)Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom, (3)Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, (4)Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, (5)Department of Haematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark


    T. Aagaard, None

    A. Roen, None

    G. Daugaard, None

    P. Brown, None

    H. Sengeløv, None

    A. Mocroft, None

    J. Lundgren, None

    M. Helleberg, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.