Real-world evidence from a tertiary academic center: clinical characteristics, microbiology and outcomes of oncology patients with febrile neutropenia presenting to the emergency department

BACKGROUND: Febrile neutropenia (FN) remains a frequent complication of cytotoxic chemotherapy despite G-CSF prophylaxis and is associated with substantial morbidity and mortality. This study characterized FN presentations to the emergency department (ED) and identified patient-, treatment- and microbiological factors associated with patient outcome. METHODS AND MATERIAL: This retrospective single-centre real-world cohort study included adult patients (≥18 years) with histologically confirmed malignancies who had received at least one line of systemic therapy and presented to the ED of the Medical University of Vienna with FN between August 2016 and December 2019. Demographic, clinical, microbiological, treatment-related and outcome data were extracted from electronic medical records. Univariable and multivariable logistic regression models were used to identify variables associated with in-hospital and 3-month mortality. RESULTS: Ninety patients with FN were analysed (median age 65 years, range 18-87, 42% female). The most common malignancies were lymphoma (22%), hematologic malignancies (11%) and lung cancer (11%). In-hospital and 3-month mortality rates were 18% and 29%, respectively. Non-survivors more frequently presented with hepatic or pulmonary metastases (both p = 0.009), palliative treatment intent (p < 0.001) and lower rates of therapeutic G-CSF administration (p = 0.013). Elevated CRP on admission was associated with in-hospital mortality (p = 0.007), whereas higher LDH levels were associated with 3-month mortality (p = 0.016). Blood culture positivity was common (33/84; 39%) and associated with higher in-hospital mortality (p = 0.007) and reduced 3-month survival (p = 0.006). In the multivariable analysis, no single factor was significantly associated with in-hospital mortality, whereas elevated LDH (aOR 1.01 per U/L, p = 0.008), positive blood culture (aOR 6.71, p = 0.010) and curative treatment intent (aOR 0.085, p = 0.036) were associated with 3-month mortality. CONCLUSIONS: FN remains associated with substantial short-term mortality, particularly in patients with palliative treatment setting, elevated inflammatory markers or positive blood cultures. Therapeutic G-CSF use showed a protective association, whereas higher CRP and LDH levels were associated with adverse outcomes.