Table 4.
Effect of treatment patterns on outcome for low and high-risk patients with febrile neutropenia.
| Low-risk patients | High-risk patients | ||||
|---|---|---|---|---|---|
| Non-routine discharge (n=882) |
Death (n=273) | Non-routine discharge (n=619) |
Death (n=555) | ||
| Age | |||||
| <60 years | Referent | Referent | Referent | Referent | |
| ≥60 years | 2.16 (0.88–1.27) | 2.71 (1.62–4.54)* | 1.53 (1.17–2.00)* | 1.61 (1.15–2.25)* | |
| Gender | |||||
| Male | Referent | Referent | Referent | Referent | |
| Female | 1.05 (0.88–1.27) | 0.98 (0.66–1.47) | 1.22 (0.99–1.51) | 0.98 (0.74–1.28) | |
| Year of diagnosis | |||||
| 2000–2003 | Referent | Referent | Referent | Referent | |
| 2004–2006 | 1.07 (0.87–1.31) | 0.73 (0.46–1.16) | 1.01 (0.78–1.31) | 0.70 (0.50–0.97)* | |
| 2007–2010 | 0.95 (0.78–1.17) | 0.61 (0.37–1.01) | 0.96 (0.74–1.23) | 0.66 (0.48–0.90)* | |
| Race | |||||
| White | Referent | Referent | Referent | Referent | |
| Black | 1.25 (0.96–1.63) | 1.32 (0.70–2.52) | 1.01 (0.75–1.38) | 1.16 (0.77–1.74) | |
| Other | 0.92 (0.74–1.14) | 1.08 (0.59–1.98) | 0.72 (0.55–0.95)* | 0.99 (0.70–1.39) | |
| Marital status | |||||
| Married | Referent | Referent | Referent | Referent | |
| Single | 2.31 (1.83–2.92)* | 0.86 (0.45–1.62) | 1.60 (1.20–2.13)* | 1.17 (0.81–1.70) | |
| Unknown | 1.84 (1.54–2.20)* | 0.84 (0.55–1.28) | 1.58 (1.29–1.94)* | 0.94 (0.72–1.24) | |
| Insurance status | |||||
| Medicare | Referent | Referent | Referent | Referent | |
| Medicaid | 0.57 (0.40–0.80)* | 1.47 (0.71–3.07) | 0.54 (0.36–0.82)* | 0.65 (0.38–1.11) | |
| Commercial | 0.50 (0.40–0.61)* | 0.65 (0.41–1.03) | 0.56 (0.44–0.71)* | 0.73 (0.54–0.99)* | |
| Uninsured | 0.34 (0.16–0.71)* | 1.82 (0.59–5.61) | 0.07 (0.01–0.51)* | 0.85 (0.35–2.11) | |
| Unknown | 0.48 (0.25–0.92)* | 1.22 (0.36–4.21) | 0.37 (0.16–0.87)* | 0.95 (0.41–2.20) | |
| Location | |||||
| Metropolitan | Referent | Referent | Referent | Referent | |
| Non-metropolitan | 0.87 (0.66–1.15) | 0.89 (0.30–2.66) | 1.01 (0.76–1.34) | 1.07 (0.72–1.60) | |
| Teaching status | |||||
| Non-teaching | Referent | Referent | Referent | Referent | |
| Teaching | 0.96 (0.78–1.19) | 0.94 (0.40–2.20) | 0.98 (0.78–1.23) | 0.91 (0.67–1.25) | |
| Hospital size | |||||
| <400 beds | Referent | Referent | Referent | Referent | |
| 400–600 beds | 1.13 (0.90–1.41) | 1.22 (0.50–3.01) | 1.07 (0.84–1.36) | 0.80 (0.57–1.13) | |
| >600 beds | 0.99 (0.73–1.33) | 1.21 (0.37–3.93) | 1.01 (0.73–1.38) | 0.88 (0.57–1.34) | |
| Hospital location | |||||
| Eastern | Referent | Referent | Referent | Referent | |
| Midwest | 0.82 (0.62–1.08) | 0.64 (0.19–2.20) | 1.24 (0.91–1.70) | 0.57 (0.36–0.88)* | |
| Southern | 0.61 (0.47–0.80)* | 0.83 (0.28–2.46) | 0.95 (0.70–1.27) | 0.73 (0.49–1.10) | |
| West | 0.69 (0.50–0.96)* | 0.92 (0.23–3.63) | 0.95 (0.65–1.37) | 0.70 (0.43–1.14) | |
| Comorbidity | |||||
| <2 | Referent | Referent | Referent | Referent | |
| 2 | 1.50 (1.07–2.10)* | 1.90 (0.84–4.27) | 1.47 (0.92–2.34) | 1.50 (0.85–2.66) | |
| >2 | 1.89 (1.42–2.52)* | 2.26 (1.11–4.60)* | 1.81 (1.20–2.73)* | 1.49 (0.90–2.45) | |
| Physician specialty | |||||
| Medical oncology | Referent | Referent | Referent | Referent | |
| Internal medicine | 1.81 (1.43–2.28)* | 1.18 (0.46–3.03) | 1.80 (1.40–2.32)* | 0.98 (0.70–1.37) | |
| Family practice | 1.74 (1.24–2.43)* | 1.15 (0.28–4.75) | 1.91 (1.31–2.79)* | 1.07 (0.64–1.80) | |
| Hospitalist | 2.31 (1.55–3.45)* | 0.54 (0.05–6.40) | 1.40 (0.88–2.22) | 0.77 (0.40–1.46) | |
| Other | 1.30 (0.87–1.96) | 1.11 (0.24–5.26) | 1.41 (0.88–2.27) | 1.00 (0.52–1.92) | |
| Unknown | 1.33 (0.75–2.37) | 2.53 (0.42–15.11) | 1.81 (0.99–3.30* | 0.91 (0.35–2.35) | |
| Physician volume | |||||
| Low | Referent | Referent | Referent | Referent | |
| Intermediate | 0.95 (0.77–1.18) | 0.78 (0.32–1.90) | 1.07 (0.85–1.35) | 0.86 (0.62–1.18) | |
| High | 1.06 (0.80–1.40) | 0.76 (0.25–2.26) | 1.10 (0.82–1.49) | 0.74 (0.49–1.11) | |
| Hospital volume | |||||
| Low | Referent | Referent | Referent | Referent | |
| Intermediate | 0.86 (0.69–1.07) | 0.78 (0.43–2.48) | 0.79 (0.63–1.00) | 1.20 (0.87–1.66) | |
| High | 0.59 (0.45–0.79)* | 0.68 (0.22–2.15) | 0.74 (0.55–1.00)* | 1.14 (0.76–1.72) | |
| Primary tumor site | |||||
| Colorectal | 0.78 (0.44–1.39) | 2.83 (0.86–9.34) | 1.25 (0.61–2.55) | 1.48 (0.61–3.58) | |
| Other gastrointestinal | 0.66 (0.36–1.20) | 2.47 (0.72–8.45) | 1.12 (0.54–2.32) | 1.14 (0.47–2.78) | |
| Head and neck | 0.88 (0.47–1.63) | 0.84 (0.21–3.29) | 0.77 (0.35–1.68) | 0.85 (0.34–2.12) | |
| Lung | 0.61 (0.35–1.07) | 3.76 (1.17–12.06)* | 1.03 (0.52–2.04) | 1.82 (0.78–4.24) | |
| Breast | 0.34 (0.19–0.61)* | 0.56 (0.16–1.90) | 0.73 (0.35–1.49) | 0.89 (0.37–2.18) | |
| Skin | 1.07 (.47–2.47) | 0.49 (0.04–6.65) | 1.73 (0.52–5.74) | 1.69 (0.38–7.59) | |
| Soft tissue | 0.36 (0.17–0.78)* | 0.74 (0.13–4.21) | 1.34 (0.57–3.14) | 1.55 (0.53–4.54) | |
| Genitourinary | 0.79 (0.44–1.43) | 0.58 (0.15–2.30) | 1.21 (0.59–2.48) | 0.97 (0.39–2.43) | |
| Gynecologic | 0.73 (0.39–1.35) | 2.55 (0.69–9.50) | 0.89 (0.40–1.95) | 1.58 (0.59–4.23) | |
| Lymphoma | 0.75 (0.42–1.35) | 0.35 (0.09–1.36) | 0.82 (0.40–1.68) | 0.72 (0.29–1.75) | |
| Brain | 3.70 (1.74–7.90)* | 1.82 (0.20–16.32) | 3.77 (1.44–9.86)* | 0.78 (0.16–3.70) | |
| Treatment | |||||
| Guideline-based antibiotics | 0.77 (0.65–0.92)* | 0.63 (0.42–0.95)* | 1.02 (0.80–1.31) | 0.80 (0.59–1.09) | |
| Vancomycin | 1.39 (1.17–1.65)* | 1.70 (1.12–2.59)* | 1.69 (1.38–2.08)* | 0.98 (0.76–1.27) | |
| Granulocyte colony stimulating factor | 1.15 (0.97–1.35) | 1.64 (1.08–2.50)* | 1.09 (0.90–1.34) | 0.89 (0.69–1.16) | |
| Disease characteristics | |||||
| Sepsis | - | - | 0.94 (0.76–1.16) | 3.15 (2.30–4.30)* | |
| Pneumonia | - | - | 1.15 (0.92–1.43) | 1.46 (1.10–1.95)* | |
| Intensive care use | - | - | 1.59 (1.29–1.96)* | 2.76 (2.06–3.70)* | |
| Hypotension | - | - | 1.02 (0.50–2.08) | 3.11 (1.32–7.31)* | |
| Mechanical ventilation | - | - | 1.14 (0.82–1.57) | 27.38 (13.35–56.16)* | |
*
p<0.05