Clinical Outcome of Febrile Neutropenia and Associated Factors Among Adult Patients with Cancer Treated at Ethiopian Oncology Centers: A Retrospective Observational Study

Abstract

INTRODUCTION: Febrile neutropenia (FN) is a major cause of dose-limiting complications in cancer treatment that predisposes patients to serious infections. Despite advancements in therapies, including empirical and definitive antibiotics, FN remains a major morbidity and mortality issue among patients with cancer undergoing cancer treatment. Little is known about the 30-day all-cause mortality rates from FN in Ethiopia, particularly in the Northwest Ethiopia oncology centers. METHODS: This retrospective cross-sectional study was conducted via chart review without direct patient contact at two Northwest Ethiopia oncology centers. Adult patients diagnosed with cancer who developed FN and were treated at the two oncology centers between July 2017 and July 2021 were included in the study. Multivariable logistic regression was used to identify factors associated with 30-day all-cause mortality, with statistical significance determined at P < 0.05 and a 95% confidence interval (CI). RESULTS: A total of 405 patients with FN were included in the final analysis. The overall 30-day all-cause mortality was 20.7%. Age > 60 years [adjusted odds ratio (AOR) = 3.1, 95% CI (1.6-5.9), P = 0.009], low Multinational Association for Supportive Care in Cancer (MASCC) score [AOR = 4.8, 95% CI (2.5-9.1), P = 0.0001], hypoalbuminemia [AOR = 2.8, 95% CI (1.4-5.8), P = 0.026], lymphopenia [AOR = 4.9, 95% CI (2.9-6.5), P = 0.001], and elevated gamma-glutamyl transferase (GGT) [AOR = 3.5, 95% CI (1.5-4.7), P = 0.009] were significantly associated with 30-day all-cause mortality. CONCLUSION: The 30-day all-cause mortality rate was high among patients with FN. Old age, low MASCC score, hypoalbuminemia, lymphopenia, and elevated GGT levels were found to be significantly associated with 30-day all-cause mortality. Healthcare providers should consider these factors in order to manage and mitigate the risks associated with the 30-day all-cause mortality. Further prospective studies are warranted to confirm our results and identify therapeutic strategies that can improve survival.