Clinical characteristics and therapeutic outcome of patients with febrile neutropenia who present in shock: Need for better strategies

Objective: To study the frequency of neutropenic febrile patients who prese nt in shock, to evaluate the influence of this presenting feature on respon se to antibiotic therapy morbidity, and mortality and to identify discrimin ating demographic features and clinical characteristics of these individual s, Methods: Prospectively collected data on all episodes of fever and neutr openia observed in cancer patients who were hospitalized for parenteral ant ibiotic therapy, Results: Five hundred and seventy-six patients were evalua ted; 22 (3.8%) presented in shock. This group of individuals was compared w ith the remainder, Patients presenting in shock were more likely to be olde r (P = 0.01) and have progressive unresponsive cancer (P < 0.01), They were also more likely to present with septic appearance (P < 0.01), dehydration (P < 0.01), diarrhoea (P < 0.01), altered mental status(P < 0.01) clinical bleeding (P = 0.02) and dyspnoea (P < 0.01), They more often had anaemia ( P < 0.01), thrombocytopenia (P = 0.02) and abnormal liver function tests (P < 0.01), Eight of the 22 patients presenting in shock had documented bacte raemia, Non-bacteraemic microbiological infections were observed in three p atients. Five patients had clinical evidence of infection and another five were severely dehydrated and volume depleted, One patient had cardiogenic s hock. Three patients were managed with monotherapy, 19 received combination antibiotics as initial empirical therapy Overall outcome of these patients was extremely poor, particularly those with infectious aetiology. Eighteen (82%) patients expired, Conclusion: Neutropenic febrile patients who prese nt in shock have extremely poor outcomes irrespective of type of initial an tibiotic therapy, Intense efforts are required to improve their outcome. (C ) 2001 The British Infection Society.