Temperature Trajectory Subphenotypes in Oncology Patients with Neutropenia and Suspected Infection

Despite etiologic and severity heterogeneity in neutropenic sepsis, management is often uniform. Understanding host response clinical subphenotypes might inform treatment strategies for neutropenic sepsis. In this retrospective two-hospital study, we analyzed whether temperature trajectory modeling could identify distinct, clinically relevant subphenotypes among oncology patients with neutropenia and suspected infection. Among adult oncologic admissions with neutropenia and blood cultures within 24 hours, a previously validated model classified patients' initial 72-hour temperature trajectories into one of four subphenotypes. We analyzed subphenotypes' independent relationships with hospital mortality and bloodstream infection using multivariable models. Patients (primary cohort = 1,145, validation cohort = 6,564) fit into one of four temperature subphenotypes. "Hyperthermic slow resolvers" (pooled = 1,140 [14.8%], mortality = 104 [9.1%]) and "hypothermic" encounters ( = 1,612 [20.9%], mortality = 138 [8.6%]) had higher mortality than "hyperthermic fast resolvers" ( = 1,314 [17.0%], mortality = 47 [3.6%]) and "normothermic" ( = 3,643 [47.3%], mortality = 196 [5.4%]) encounters (