Neutropenic Enterocolitis: Clinical Features and Outcomes.

BACKGROUND Patients undergoing chemotherapy are at risk for mucosal injury and neutropenia, which facilitate colonic mucosal invasion by the bowel flora and subsequent neutropenic enterocolitis, which has a poor prognosis. OBJECTIVE This study aimed to assess the clinical features and outcomes of neutropenic enterocolitis in patients at a comprehensive cancer center. DESIGN This is a retrospective cohort study. SETTING The study was conducted at the University of Texas MD Anderson Cancer Center. PATIENTS Neutropenic enterocolitis was defined by the presence of an absolute neutrophil count <1000/mm, compatible abdominal symptoms, and either mucosal thickening on abdominal imaging or mucosal injury on colon biopsy. Patients who had been diagnosed between 2010 and 2018 were included. MAIN OUTCOMES Complication and survival rates were analyzed using logistic regression and Cox regression analyses, respectively. RESULTS Of the 49,244 patients who had neutropenia during the study period, 134 (2.7%) were included. The median time from neutropenia onset to neutropenic enterocolitis was 2 days (interquartile range, 1-10 days). Neutropenic enterocolitis symptoms lasted for a median of 11 days (interquartile range, 6-22 days). Most patients received antibiotics (88%) and granulocyte colony-stimulating factor (68%). Complications included sepsis (11%), colonic perforation (2%), pneumatosis intestinalis (2%), and abscess formation (2%). The risks associated with complications included immunosuppressive therapy use within 1 month before neutropenic enterocolitis onset (OR, 3.92; 95% CI, 1.04-14.76) and delayed imaging (OR, 1.10; 95% CI, 1.03-1.17). Older age, severe neutropenia, prolonged neutropenia before and after neutropenic enterocolitis diagnosis, and other concomitant systemic infections were associated with lower survival rates. LIMITATIONS The performance of this study at a single center and its retrospective nature are limitations of the study. CONCLUSION The prompt diagnosis and management of neutropenic enterocolitis are critical to prevent complications. The use of granulocyte colony-stimulating factor can be beneficial to shorten the duration of neutropenia. See Video Abstract at http://links.lww.com/DCR/B116. ENTEROCOLITIS NEUTROPENICA: CARACTERISTICAS CLINICAS Y RESULTADOS: Los pacientes sometidos a quimioterapia, estan en riesgo de lesion de la mucosa y neutropenia, lo que facilita la invasion de la mucosa colonica por la flora intestinal y la subsecuente enterocolitis neutropenica, con un mal pronostico.Evaluar las caracteristicas clinicas y los resultados de la enterocolitis neutropenica de pacientes en un centro integral de cancer.Estudio de cohorte retrospectivo.El estudio se realizo en el MD Anderson Cancer Center de la Universidad de Texas.Se definio la enterocolitis neutropenica, como la presencia de un recuento absoluto de neutrofilos <1000 / mm3, con sintomas compatibles abdominales y engrosamiento de la mucosa en imagen abdominal o lesion de la mucosa en biopsia de colon. Se incluyeron pacientes diagnosticados entre 2010 y 2018.Se analizaron las tasas de complicaciones y supervivencia mediante analisis de regresion logistica y regresion de Cox.De 49,244 pacientes que tuvieron neutropenia durante el periodo de estudio, 134 (2.7%) fueron incluidos. La media del tiempo desde el inicio de la neutropenia hasta la enterocolitis neutropenica, fue de 2 dias (RIC, 1-10 dias). Los sintomas de enterocolitis neutropenica duraron una media de 11 dias (RIC, 6-22 dias). La mayoria de los pacientes recibieron antibioticos (88%) y factor estimulante de colonias de granulocitos (68%). Las complicaciones incluyeron sepsis (11%), perforacion colonica (2%), neumatosis intestinal (2%) y formacion de abscesos (2%). Los riesgos asociados con las complicaciones incluyeron, uso de terapia inmunosupresora dentro de 1 mes antes del inicio de la enterocolitis neutropenica (razon de probabilidades 3.92; intervalo de confianza del 95% 1.04-14.76) y demora en la obtencion de imagenes (razon de probabilidades 1.10; intervalo de confianza del 95% 1.03-1.17), edad avanzada, neutropenia grave, neutropenia prolongada antes y despues del diagnostico de enterocolitis neutropenica y de otras infecciones sistemicas concomitantes, se asociaron con bajas tasas de supervivencia.Centro unico y estudio retrospectivo.El rapidodiagnostico y manejo de la enterocolitis neutropenica, es critico para prevenir complicaciones. El uso del factor estimulante de colonias de granulocitos puede ser beneficioso para acortar la duracion de la neutropenia. Consulte Video Resumen en http://links.lww.com/DCR/B116.