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Incidence and impact of baseline electrolyte abnormalities in patients admitted with chemotherapy induced febrile neutropenia.

Shaikh AJ, Bawany SA, Masood N, Khan AA, Abbasi AN, Niamutullah SN, Zaidi A, Adil S, Kumar S - J Cancer (2011)

Bottom Line: Various factors are known to affect the outcomes for patients diagnosed with FN.Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not.Special attention should be paid to electrolyte imbalance right from the outset.

View Article: PubMed Central - PubMed

Affiliation: 1. Department of medicine, Section of Hematology and Oncology, The Aga Khan University Hospital, Karachi, Pakistan.

ABSTRACT

Background: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature.

Methods: This was a prospective, observational study. A total of two hundred and fifteen (215) patients admitted between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0.Toxicity profile was graded according to CTC version 3.0.

Results: Almost equal number of FN was observed in both solid tumors and hematological cancers with almost equal gender distribution. Of all 83.5% patients demonstrated some electrolyte abnormalities. All grades combined, hypokalemia was seen in 48% of patients, with 51.4% having grade I, 33.3% grade III and 15.2% G IV (life threatening) hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, of them 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia (70 patients assessed) was seen in 54.3% patient, 94.7% having grade I decline. Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not. Out of 90 patients who required special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalities

Conclusion: This analysis, which is first of its kind, suggests that decline in electrolyte levels is frequently observed in patients presenting with FN. These abnormalities can have independent negative impact on the outcome for such patients. Special attention should be paid to electrolyte imbalance right from the outset.

No MeSH data available.


Related in: MedlinePlus

Average Length of stay per Iv replacement and outcome.
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Figure 3: Average Length of stay per Iv replacement and outcome.

Mentions: Chemotherapy induced FN is a serious oncologic emergency with a potential to have a fatal out-come 11, 12. There are on average about 200 admissions in a year, to our hospital with a diagnosis of chemotherapy induced febrile neutropenia. Clinical parameters to predict outcomes in FN patients have been studied and various risk stratification guidelines are proposed 115. In the present era of modern antibiotic therapy, where coverage against most infective organisms is available, factors other than infection itself are becoming increasingly evident as predictors of outcome in FN 13. Electrolyte abnormalities per se have not been as yet nominated as one of the factors for predicting a worse outcome, indirectly though, mucosal breach associated with cytotoxic chemotherapy has been suspected to be a cause of worse out comes in patients having cytopenia secondary to chemotherapy, compared to those who have neutropenia secondary to viral infections 14. What exactly causes the electrolyte abnormalities that are observed with FN remains to be elucidated, but results from our study suggest that it seems very unlikely that only vomiting or diarrhea associated with chemotherapy are the cause, as only 12% of our patients were found to have the two co-exist. Similarly most of the patients also had a preserved renal function when depicting electrolyte loss. Analyzed as a single variable, electrolyte abnormalities requiring IV administration resulted in a longer stay by approximately more than one and half days (Figure 3). The fact that most of the patient who died had some degree of electrolyte imbalance, both hypokalemia and hyponatremia, carries weight but is not statistically significant because of a smaller sample size. The need of IV replacement of K+ made shifting of patients to special care rooms with cardiac monitor necessary, the special care transfer and longer stay are a reason for increasing treatment cost 15. We did not find any difference with regards to gender or type of malignancy (whether solid or hematological) with reference to development of FN and/or electrolyte deficit, but we saw that more male patients who died demonstrated electrolyte imbalance compared to females. The overall mortality attributed to FN in our series was comparable to that seen in international literature. Whereas, we observed almost a similar number of patients suffering from hematological and solid tumors, most of the published literature shows a trend towards more incidence for hematological cancers 11. We, in contrast, to other studies did not find the increasing age to be more associated with deaths, we assume that the reason is because more elderly patients are given prophylactic G-CSFs now, then before, therefore the number would have been quite less to affect the analysis.


Incidence and impact of baseline electrolyte abnormalities in patients admitted with chemotherapy induced febrile neutropenia.

Shaikh AJ, Bawany SA, Masood N, Khan AA, Abbasi AN, Niamutullah SN, Zaidi A, Adil S, Kumar S - J Cancer (2011)

Average Length of stay per Iv replacement and outcome.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3039222&req=5

Figure 3: Average Length of stay per Iv replacement and outcome.
Mentions: Chemotherapy induced FN is a serious oncologic emergency with a potential to have a fatal out-come 11, 12. There are on average about 200 admissions in a year, to our hospital with a diagnosis of chemotherapy induced febrile neutropenia. Clinical parameters to predict outcomes in FN patients have been studied and various risk stratification guidelines are proposed 115. In the present era of modern antibiotic therapy, where coverage against most infective organisms is available, factors other than infection itself are becoming increasingly evident as predictors of outcome in FN 13. Electrolyte abnormalities per se have not been as yet nominated as one of the factors for predicting a worse outcome, indirectly though, mucosal breach associated with cytotoxic chemotherapy has been suspected to be a cause of worse out comes in patients having cytopenia secondary to chemotherapy, compared to those who have neutropenia secondary to viral infections 14. What exactly causes the electrolyte abnormalities that are observed with FN remains to be elucidated, but results from our study suggest that it seems very unlikely that only vomiting or diarrhea associated with chemotherapy are the cause, as only 12% of our patients were found to have the two co-exist. Similarly most of the patients also had a preserved renal function when depicting electrolyte loss. Analyzed as a single variable, electrolyte abnormalities requiring IV administration resulted in a longer stay by approximately more than one and half days (Figure 3). The fact that most of the patient who died had some degree of electrolyte imbalance, both hypokalemia and hyponatremia, carries weight but is not statistically significant because of a smaller sample size. The need of IV replacement of K+ made shifting of patients to special care rooms with cardiac monitor necessary, the special care transfer and longer stay are a reason for increasing treatment cost 15. We did not find any difference with regards to gender or type of malignancy (whether solid or hematological) with reference to development of FN and/or electrolyte deficit, but we saw that more male patients who died demonstrated electrolyte imbalance compared to females. The overall mortality attributed to FN in our series was comparable to that seen in international literature. Whereas, we observed almost a similar number of patients suffering from hematological and solid tumors, most of the published literature shows a trend towards more incidence for hematological cancers 11. We, in contrast, to other studies did not find the increasing age to be more associated with deaths, we assume that the reason is because more elderly patients are given prophylactic G-CSFs now, then before, therefore the number would have been quite less to affect the analysis.

Bottom Line: Various factors are known to affect the outcomes for patients diagnosed with FN.Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not.Special attention should be paid to electrolyte imbalance right from the outset.

View Article: PubMed Central - PubMed

Affiliation: 1. Department of medicine, Section of Hematology and Oncology, The Aga Khan University Hospital, Karachi, Pakistan.

ABSTRACT

Background: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature.

Methods: This was a prospective, observational study. A total of two hundred and fifteen (215) patients admitted between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0.Toxicity profile was graded according to CTC version 3.0.

Results: Almost equal number of FN was observed in both solid tumors and hematological cancers with almost equal gender distribution. Of all 83.5% patients demonstrated some electrolyte abnormalities. All grades combined, hypokalemia was seen in 48% of patients, with 51.4% having grade I, 33.3% grade III and 15.2% G IV (life threatening) hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, of them 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia (70 patients assessed) was seen in 54.3% patient, 94.7% having grade I decline. Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not. Out of 90 patients who required special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalities

Conclusion: This analysis, which is first of its kind, suggests that decline in electrolyte levels is frequently observed in patients presenting with FN. These abnormalities can have independent negative impact on the outcome for such patients. Special attention should be paid to electrolyte imbalance right from the outset.

No MeSH data available.


Related in: MedlinePlus