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...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2023-05, Vol.207 (10), p.1300-1309 |
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| creator | Benzoni, Nicole S Carey, Kyle A Bewley, Alice F Klaus, Jeff Fuller, Brian M Edelson, Dana P Churpek, Matthew M Bhavani, Sivasubramanium V Lyons, Patrick G |
| description | 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 (
|
| doi_str_mv | 10.1164/rccm.202205-0920OC |
| format | Article |
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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 (
< 0.001). Bloodstream infections were more common among hyperthermic slow resolvers (
= 248 [21.8%]) and hyperthermic fast resolvers (
= 240 [18.3%]) than among hypothermic (
= 188 [11.7%]) or normothermic (
= 418 [11.5%]) encounters (
< 0.001). Adjusted for confounders, hyperthermic slow resolvers had increased adjusted odds for mortality (primary cohort odds ratio, 1.91 [
= 0.03]; validation cohort odds ratio, 2.19 [
< 0.001]) and bloodstream infection (primary odds ratio, 1.54 [
= 0.04]; validation cohort odds ratio, 2.15 [
< 0.001]).
Temperature trajectory subphenotypes were independently associated with important outcomes among hospitalized patients with neutropenia in two independent cohorts.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.202205-0920OC</identifier><identifier>PMID: 36449534</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Adult ; Body temperature ; Fever ; Humans ; Infections ; Neoplasms - complications ; Neoplasms - therapy ; Neutropenia ; Neutropenia - complications ; Oncology ; Original ; Retrospective Studies ; Sepsis ; Sepsis - complications ; Temperature</subject><ispartof>American journal of respiratory and critical care medicine, 2023-05, Vol.207 (10), p.1300-1309</ispartof><rights>Copyright American Thoracic Society May 15, 2023</rights><rights>Copyright © 2023 by the American Thoracic Society 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c387t-bd325e92bf3d6f4efb1882a7118936f19135d4fbc43aacdf21e2be549bddb76a3</citedby><cites>FETCH-LOGICAL-c387t-bd325e92bf3d6f4efb1882a7118936f19135d4fbc43aacdf21e2be549bddb76a3</cites><orcidid>0000-0003-3757-756X ; 0000-0001-5392-4010 ; 0000-0002-4030-5250 ; 0000-0002-2040-7276 ; 0000-0002-1557-2787 ; 0000-0002-9640-6720</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4011,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36449534$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Benzoni, Nicole S</creatorcontrib><creatorcontrib>Carey, Kyle A</creatorcontrib><creatorcontrib>Bewley, Alice F</creatorcontrib><creatorcontrib>Klaus, Jeff</creatorcontrib><creatorcontrib>Fuller, Brian M</creatorcontrib><creatorcontrib>Edelson, Dana P</creatorcontrib><creatorcontrib>Churpek, Matthew M</creatorcontrib><creatorcontrib>Bhavani, Sivasubramanium V</creatorcontrib><creatorcontrib>Lyons, Patrick G</creatorcontrib><title>Temperature Trajectory Subphenotypes in Oncology Patients with Neutropenia and Suspected Infection</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>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 (
< 0.001). Bloodstream infections were more common among hyperthermic slow resolvers (
= 248 [21.8%]) and hyperthermic fast resolvers (
= 240 [18.3%]) than among hypothermic (
= 188 [11.7%]) or normothermic (
= 418 [11.5%]) encounters (
< 0.001). Adjusted for confounders, hyperthermic slow resolvers had increased adjusted odds for mortality (primary cohort odds ratio, 1.91 [
= 0.03]; validation cohort odds ratio, 2.19 [
< 0.001]) and bloodstream infection (primary odds ratio, 1.54 [
= 0.04]; validation cohort odds ratio, 2.15 [
< 0.001]).
Temperature trajectory subphenotypes were independently associated with important outcomes among hospitalized patients with neutropenia in two independent cohorts.</description><subject>Adult</subject><subject>Body temperature</subject><subject>Fever</subject><subject>Humans</subject><subject>Infections</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - therapy</subject><subject>Neutropenia</subject><subject>Neutropenia - complications</subject><subject>Oncology</subject><subject>Original</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Sepsis - complications</subject><subject>Temperature</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkV1rFDEUhoNYbF39A17IgDfeTJvP-bgSWdpaKK7gCt6FfJx0s8wkYzJT2X_flK1Fvcoh57wv7zkPQu8IPiek4RfJmPGcYkqxqHFP8Wb9Ap0RwUTN-xa_LDVuWc15__MUvc55jzGhHcGv0Clryq9g_AzpLYwTJDUvCaptUnswc0yH6vuipx2EOB8myJUP1SaYOMS7Q_VNzR7CnKvfft5VX2GZU5wgeFWpYIsuT8UCbHUTXCl8DG_QiVNDhrdP7wr9uLrcrr_Ut5vrm_Xn29qwrp1rbRkV0FPtmG0cB6dJ11HVEtL1rHGkJ0xY7rThTCljHSVANQjea2t12yi2Qp-OvtOiR7CmhExqkFPyo0oHGZWX_3aC38m7eC8JFr3gghWHj08OKf5aIM9y9NnAMKgAccmStpwJLJoSZYU-_De6j0sKZT9ZbsyxwE058ArR45RJMecE7jkNwfKRoXxkKI8M5ZFhEb3_e49nyR9o7AHaVJvw</recordid><startdate>20230515</startdate><enddate>20230515</enddate><creator>Benzoni, Nicole S</creator><creator>Carey, Kyle A</creator><creator>Bewley, Alice F</creator><creator>Klaus, Jeff</creator><creator>Fuller, Brian M</creator><creator>Edelson, Dana P</creator><creator>Churpek, Matthew M</creator><creator>Bhavani, Sivasubramanium V</creator><creator>Lyons, Patrick G</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3757-756X</orcidid><orcidid>https://orcid.org/0000-0001-5392-4010</orcidid><orcidid>https://orcid.org/0000-0002-4030-5250</orcidid><orcidid>https://orcid.org/0000-0002-2040-7276</orcidid><orcidid>https://orcid.org/0000-0002-1557-2787</orcidid><orcidid>https://orcid.org/0000-0002-9640-6720</orcidid></search><sort><creationdate>20230515</creationdate><title>Temperature Trajectory Subphenotypes in Oncology Patients with Neutropenia and Suspected Infection</title><author>Benzoni, Nicole S ; Carey, Kyle A ; Bewley, Alice F ; Klaus, Jeff ; Fuller, Brian M ; Edelson, Dana P ; Churpek, Matthew M ; Bhavani, Sivasubramanium V ; Lyons, Patrick G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c387t-bd325e92bf3d6f4efb1882a7118936f19135d4fbc43aacdf21e2be549bddb76a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Body temperature</topic><topic>Fever</topic><topic>Humans</topic><topic>Infections</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - therapy</topic><topic>Neutropenia</topic><topic>Neutropenia - complications</topic><topic>Oncology</topic><topic>Original</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Sepsis - complications</topic><topic>Temperature</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Benzoni, Nicole S</creatorcontrib><creatorcontrib>Carey, Kyle A</creatorcontrib><creatorcontrib>Bewley, Alice F</creatorcontrib><creatorcontrib>Klaus, Jeff</creatorcontrib><creatorcontrib>Fuller, Brian M</creatorcontrib><creatorcontrib>Edelson, Dana P</creatorcontrib><creatorcontrib>Churpek, Matthew M</creatorcontrib><creatorcontrib>Bhavani, Sivasubramanium V</creatorcontrib><creatorcontrib>Lyons, Patrick G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Benzoni, Nicole S</au><au>Carey, Kyle A</au><au>Bewley, Alice F</au><au>Klaus, Jeff</au><au>Fuller, Brian M</au><au>Edelson, Dana P</au><au>Churpek, Matthew M</au><au>Bhavani, Sivasubramanium V</au><au>Lyons, Patrick G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Temperature Trajectory Subphenotypes in Oncology Patients with Neutropenia and Suspected Infection</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2023-05-15</date><risdate>2023</risdate><volume>207</volume><issue>10</issue><spage>1300</spage><epage>1309</epage><pages>1300-1309</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>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 (
< 0.001). Bloodstream infections were more common among hyperthermic slow resolvers (
= 248 [21.8%]) and hyperthermic fast resolvers (
= 240 [18.3%]) than among hypothermic (
= 188 [11.7%]) or normothermic (
= 418 [11.5%]) encounters (
< 0.001). Adjusted for confounders, hyperthermic slow resolvers had increased adjusted odds for mortality (primary cohort odds ratio, 1.91 [
= 0.03]; validation cohort odds ratio, 2.19 [
< 0.001]) and bloodstream infection (primary odds ratio, 1.54 [
= 0.04]; validation cohort odds ratio, 2.15 [
< 0.001]).
Temperature trajectory subphenotypes were independently associated with important outcomes among hospitalized patients with neutropenia in two independent cohorts.</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>36449534</pmid><doi>10.1164/rccm.202205-0920OC</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-3757-756X</orcidid><orcidid>https://orcid.org/0000-0001-5392-4010</orcidid><orcidid>https://orcid.org/0000-0002-4030-5250</orcidid><orcidid>https://orcid.org/0000-0002-2040-7276</orcidid><orcidid>https://orcid.org/0000-0002-1557-2787</orcidid><orcidid>https://orcid.org/0000-0002-9640-6720</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2023-05, Vol.207 (10), p.1300-1309 |
| issn | 1073-449X 1535-4970 |
| language | eng |
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| source | MEDLINE; American Thoracic Society (ATS) Journals Online; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Body temperature Fever Humans Infections Neoplasms - complications Neoplasms - therapy Neutropenia Neutropenia - complications Oncology Original Retrospective Studies Sepsis Sepsis - complications Temperature |
| title | Temperature Trajectory Subphenotypes in Oncology Patients with Neutropenia and Suspected Infection |
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