Offidani et al identified risk factors for patients with hematologic malignancies who developed febrile neutropenia and pulmonary infiltrates. This can help identify patients who require more aggressive monitoring and intervention. The authors are from the University of Ancona/Azienda Ospedaliera Umberto I in Italy
Patient selection:
(1) AML
(2) ALL
(3) non-Hodgkin's lymphoma
(4) multiple myeloma
(5) blast crisis in CML
Parameters:
(1) change in white blood cell count
(2) C-reactive protein level
(3) serum albumin
Parameter |
Finding |
Points |
change in white blood cell count |
favorable (recovering following aplasia; absolute neutrophil count > 500 per µL at onset of fever and pulmonary infiltrates) |
1 |
|
unfavorable (decreasing, or not recovering after aplasia) |
0 |
C-reactive protein |
< 10 mg/dL |
1 |
|
>= 10 mg/dL |
0 |
serum albumin |
< 3 g/dL |
0 |
|
>= 3 g/dL |
1 |
favorable risk factor score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the more favorable the outcome.
Favorable Risk Score |
Risk Group |
Survival Rate |
2 or 3 |
low risk |
95% |
0 or 1 |
high risk |
46% |
Performance:
• The specificity was 88% and sensitivity 75%.
• The positive predictive value was 95% and the negative predictive value was 54%.
Specialty: Infectious Diseases, Hematology Oncology