INTRODUCTION
Febrile neutropenia is a well-known complication of chemotherapy and it
is one of the most frequent oncologic emergencies treated by emergency
physicians [1]. Neutropenia often develops due to both the toxic
effect of chemotherapy and the spread of malign cells into the bone
marrow preventing the growth of hematopoietic cells. Neutrophils play an
important role against infectious agents thus neutropenic patients
become more susceptible to infections [2]. Invasive infections and
the conditions that cause sterile tissue damage may lead to an increase
in the systemic inflammation together with inflammatory mediators and
high fever. High fever in the patients with malignancy can result from
the malignant cell lysis or mucosal damage induced by chemotherapy apart
from the infections [3].
It is quite important to diagnose and treat serious infections resulting
in morbidity and mortality in febrile neutropenia in the early phase. On
the other hand, insufficient clinical and microbiological data in these
patients cause serious problems in the diagnosis of the disease [4,
5]. It is hard to distinguish the infected patients from the
non-infected ones through the use of simple inflammation parameters in
febrile neutropenia, thus reliable biomarkers are necessary for the
early prediction of the complications [3, 6]. Certain biological
markers were suggested for this purpose and their relationship with the
risk assessments was studied. The accuracy and predictive values of
these markers were generally evaluated by small-scale, single-center
clinical and laboratory studies and different results were obtained
[7-9].
The mediators released due to oxidative stress are known to cause
numerous systemic diseases accompanied by inflammation. Thiol/disulphide
homeostasis parameters have been used for the detection of oxidative
stress, and they have been measured in a one-sided way since 1979.
Today, these parameters can be measured both separately and collectively
by means of a new method developed by Erel and Neselioglu [10-13].
Moreover, PCT and CRP are the biochemical markers released in infection
and inflammation [14, 15].
Researchers have tried to develop prognostic models for many years in
order to classify patients with febrile neutropenia to foresee severe
complications and risks that may occur. In 2000, the MASCC risk scoring
index was published so as to make risk classification and especially to
identify the ambulant patients at low risk [16, 17].
This study aims to determine whether it is beneficial to use
thiol/disulphide homeostasis parameters, PCT and CRP together with the
MASCC risk scoring system for the prediction of prognosis and mortality
in the patients with febrile neutropenia presenting to the emergency
department.