We retrospectively reviewed the medical records of 284 patients with neutropenic fever following chemotherapy for acute leukemia at the Catholic Hematopoietic Stem Cell Transplantation Center from January 1998 to December 1999, to identify prognostic factors for infection related mortality. Twenty-eight patients died of infections. There was no difference in median age, gender ratio, or underlying disease between the dying and surviving groups. Bacteria were the main pathogens following chemotherapy, and Gram positive organisms predominated in the dying group. Pneumonia and sepsis were the main causes of death. There were 72 cases of invasive fungal infection and their mortality was 27.8%. Invasive fungal infection and previous history of fungal infection were independent prognostic factors for outcome. Recovery from neutropenia was the significant protective factor for mortality. In conclusion, the prognostic factors identified in this study could be useful for deciding on more intensive treatment for those patients at greater risk of death. To our knowledge, this is the first Korean study delineating prognostic factors in acute leukemic patients with infectious complications.
Adolescent ; Adult ; Aged ; Bacterial Infections/complications/*mortality ; Cause of Death ; Female ; Humans ; Korea ; Leukemia ; Leukemia, Lymphocytic, Acute/complications/*microbiology/*mortality ; Leukemia, Myelocytic, Acute/complications/*microbiology/*mortality ; Male ; Middle Aged ; Morbidity ; Multivariate Analysis ; Mycoses/complications/mortality ; Neutropenia ; Pneumonia/complications/mortality ; Prognosis ; Retrospective Studies ; Sepsis/complications/mortality ; Survival Rate

OBJECTIVETo evaluate the risk factors of chronic liver failure (CLF) complicated invasive fungal infections (IFI) and prevention and treatment.

METHODSThe clinical data and risk factors of 52 patients with CLF complicated IFI were analyzed retrospectively and were compared with those not complicated IFI. Risk factors were analyzed by chi-square test and Logistic regression test and Ridit test.

RESULTSIn 52 patients with CLF complicated IFI, there were 69 fungal infections in different tissue and organs, the most were in oral cavity, but other tissue and organs especially bellows infections were rising. Candida albicans infections were the most, but cryptococcus neoformans infections and aspergillus infections were rising. The risk factors included species of bacteria infections, serum total bilirubin, hospital days, times of antibiotics using, number of invasive operation, species of antibiotics and degrees of ascites. The mortality of patients with CLF complicated IFI were much higher than those not complicated IFI.

CONCLUSIONPatients with CLF complicated IFI have poor progress and prognosis. The effective prevent methods are treating primary disease actively, reducing hospital days, detecting patients' body fluids closely, identifying source of infection as early as possible, using antibiotics correctly, reducing or avoiding invasive operation, using immunoactivators and disinfecting air regularly.

Adult ; Aged ; Aged, 80 and over ; Female ; Hospitalization ; Humans ; Liver Failure ; complications ; Male ; Middle Aged ; Mycoses ; drug therapy ; epidemiology ; etiology ; mortality ; Retrospective Studies ; Risk Factors