医学
腹痛
中性粒细胞减少症
小肠结肠炎
前瞻性队列研究
内科学
并发症
腹部超声检查
腹泻
胃肠病学
外科
放射科
化疗
计算机断层摄影术
作者
Enrico Benedetti,Benedetto Bruno,Francesca Martini,Riccardo Morganti,Emilia Bramanti,F Caracciolo,Sara Galimberti,Piero Vincenzo Lippolis,Emanuele Neri,Chiara Arena,Francesca Cerri,Vittorio Ricchiuto,Matteo Pelosini,Enrico Orciuolo,Mario Petrini
摘要
(1) Background: Neutropenic enterocolitis (NEC) is a life-threatening complication following chemotherapy with high mortality rates. Early diagnosis is crucial to improve outcomes. We designed a large prospective study employing bedside ultrasonography (US) as a novel approach to allow early diagnosis and prompt treatment to reduce mortality. (2) Methods: NEC was defined as US or computed tomography (CT)-proven bowel wall thickness ≥ 4 mm at the onset of at least one of the following symptoms: fever and/or abdominal pain and/or diarrhea during neutropenia. From 2007 to 2018, 1754 consecutive patients underwent baseline bedside US that was invariably repeated within 12 h from the onset of symptom(s) suggestive of NEC. (3) Results: Overall, 117 episodes of NEC were observed, and overall mortality was 9.4%. Bowel wall thickening was invariably absent in the negative control group. Abdominal pain associated with one or more symptoms correlated with the highest relative risk (17.33), sensitivity (89.7%), specificity (100%), and accuracy (96.2%) for diagnosis. The combination of abdominal pain and fever at onset significantly correlated with worse survival (p < 0.0001, OR 13.85). BWT (p = 0.046), type of therapy (p = 0.049) and blood culture positivity (p = 0.003) correlated with worse survival. (4) Conclusions: Bedside ultrasound is a non-invasive and radiation free imaging technique for early diagnosis of NEC and its prompt treatment significantly reduced mortality.
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