Risk Stratification

Both the degree and duration of neutropenia are important in determining the risk for infection. Profoundly neutropenic patients, with an ANC of <100 cells/mm3, are at highest risk for infection. Those with neutrophil counts of <500 mm3 are at higher risk than those with counts of <1000/mm3. A patient who is expected to recover from chemotherapy-induced neutropenia has a different level of risk from a patient in whom neutrophil recovery is not anticipated. Neutropenia of 10 days or more duration confers greater risk. Neutropenia in patients with acute leukemia is generally of longer duration than in patients with solid tumors.

Several models of risk stratification have been developed.2 Additional risk factors for infection among leukemic patients include mucosal or integumentary breaks such as mucositis, surgical wounds, pressure ulcers, or C. difficile colitis; renal or other organ dysfunction; metabolic and nutritional factors; age; comorbidities such as diabetes mellitus; steroids or other immunosuppressive agents; and immune defects such as hypogammaglobulinemia. It is helpful to keep a paradigm of risk stratification in mind in assessing the febrile neutropenic patient.

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