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Previous issue date: 2017-08-31 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Background: Cancer is one of the three leading causes of death in Brazil, and one of the
most prevalent diseases in our country. Febrile neutropenia is a febrile syndrome associated with a reduction in neutrophil count and a frequent complication of systemic cancer treatment. Febrile neutropenia may affect up to 40% of cancer patients. Considering the large number of patients stricken by febrile neutropenia, and the risk that inadequate management imposes on patients' lives, standardization of care and the early identification of a high-risk population is key to improving clinical outcomes. Guidelines for treatment of febrile neutropenia universally recommend immediate start of antibiotic therapy (<60 minutes). Objective and Methods: The goal of this retrospective study was to evaluate the epidemiological profile and clinical outcomes of patients treated with chemotherapy or radiotherapy who met criteria for febrile neutropenia and required a visit to the emergency department of a tertiary hospital. Results: A total of 212 patients with cancer presented with fever and required an emergency room evaluation between September 2014 and August 2016. Of these, 68 met criteria for febrile neutropenia. Hematologic neoplasms were associated with an increased risk of neutropenia [OR = 3,41 (95%, CI: 1,52-7,65) p = 0,003] when compared to solid tumors. Seven (10.3%) patients with neutropenia were treated on an
outpatient setting and 61 (89,7%) were admitted. The median time to onset of the
antibiotic was 140 minutes. Of the patients admitted to the hospital, 47 (77,0%) were
discharged from hospital and 14 (23,0%) died. The median of the Multinational
Association for Supportive Care in Cancer (MASCC) score was statistically higher in
the group that was discharged when compared to the group that died (23,5 versus 14,5
points), with an OR=0,69 [(95%, CI: 0,51-0,94) p = 0,017]. Conclusion: This analysis
corroborates previously published data supporting that febrile neutropenia is a potential
morbidity and mortality factor in cancer patients. Strategies that aim to qualify the care
of patients at higher risk in the emergency room is essential to reduce mortality rates. / Introdu??o: O c?ncer ? uma das tr?s principais causas de morte no Brasil, destacando-se como uma das doen?as mais prevalentes em nosso meio. A neutropenia febril ? uma s?ndrome febril associada a redu??o na contagem do n?mero de neutr?filos, sendo uma complica??o frequente do tratamento oncol?gico sist?mico, com taxas de preval?ncia que podem atingir at? 40%. Tendo em vista o grande n?mero de pacientes oncol?gicos acometidos pela neutropenia febril, e o risco que o seu manejo inadequado imp?e ? vida
dos doentes, a padroniza??o da assist?ncia e a identifica??o precoce de uma popula??o de alto risco ? fundamental para melhorarmos os desfechos cl?nicos. As diretrizes de tratamento da neutropenia febril universalmente recomendam o in?cio imediato de antibioticoterapia (<60 minutos). Objetivo e M?todos: O objetivo do presente estudo ? avaliar, de forma retrospectiva, o perfil epidemiol?gico e os poss?veis desfechos cl?nicos de pacientes com neutropenia febril tratados com quimioterapia ou radioterapia que procuraram a emerg?ncia de um hospital terci?rio. Resultados: Um total de 212 pacientes oncol?gicos foram avaliados por febre entre Setembro de 2014 e Agosto de 2016. Destes, 68 apresentavam neutropenia febril. Neoplasias hematol?gicas foram associadas a um maior risco de neutropenia [OR = 3,41 (IC 95%: 1,52-7,65) p =
0,003], quando comparados com tumores s?lidos. Sete (10,3%) pacientes com neutropenia foram tratados a n?vel ambulatorial e 61 (89,7%) a n?vel de interna??o hospitalar. A mediana de tempo para in?cio do antibi?tico foi de 140 minutos. Dos pacientes tratados a n?vel de interna??o, 47 (77,0%) receberam alta hospitalar e 14
(23,0%) evolu?ram para ?bito. A mediana do escore ?Multinational Association for Suportive Care in Cancer? (MASCC) foi estatisticamente superior no grupo que recebeu alta hospitalar quando comparado com o grupo que evolui para ?bito (23,5 versus 14,5 pontos), com OR=0,69 (IC 95% 0,51 - 0,94) e p=0,017. Conclus?o: Esta an?lise corrobora dados previamente publicados, refor?ando que a neutropenia febril ? potencial fator de morbimortalidade em pacientes oncol?gicos. Estrat?gias que possam qualificar o atendimento de pacientes de maior risco nos setores de emerg?ncia ? fundamental para reduzir as taxas de mortalidade.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/8205 |
| Date | 31 August 2017 |
| Creators | Gelatti, Ana Caroline Zimmer |
| Contributors | Fay, Andr? Poisl, Silva, Vin?cius Duval da |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Escola de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 500, 500, 500, 600, -224747486637135387, -969369452308786627, 2075167498588264571 |
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