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Biomedical Science Doctorate Studies Risk Factors to Predict Persistent Fever in Cancer Patients After Chemotherapy
Biomedical Science Doctorate Studies Risk Factors to Predict Persistent Fever in Cancer Patients After Chemotherapy
Held in the Meeting Room on the Third Floor of the Postgraduate Program Building, Jl. PB Sudirman, Denpasar, Bali, the Biomedical Science Doctoral Study Program, Faculty of Medicine, Udayana University, held an open doctoral promotion defense with candidate Dr. Ngakan Ketut Wira Suastika, M.Biomed, Sp.PD., KHOM., with a dissertation entitled "High Levels of Fms-Like Tyrosine Kinase 3 Ligand (Flt3l) and Soluble Cd14 Subtype (Scd14-St) as Risk Factors for Persistent Fever in Malignant Patients with Febrile Neutropenia After Chemotherapy." (Febrile neutropenia (FN) is a potentially life-threatening complication of chemotherapy, where persistent fever is a sign of an uncontrolled bacterial infection. More sensitive and specific biomarkers are essential for risk stratification to prevent complications associated with bacterial infections. This study aimed to determine high levels of Fms-like tyrosine kinase-3 ligand (Flt3L) and soluble CD14 subtype (sCD14-ST) as risk factors for persistent fever in patients with malignancy with post-chemotherapy febrile neutropenia.
This was an observational study with a prospective cohort design. Subjects were patients with post-chemotherapy FN undergoing treatment at the inpatient ward of Prof. I.G.N.G. Ngoerah General Hospital, Denpasar, and recruited using a consecutive sample size. Cutoff values for Flt3L and sCD14-ST levels were obtained using the receiver operator curve (ROC) method. The chi-square test was used to determine the relative risk (95% confidence interval) of Flt3L, sCD14-ST, and their combination for the development of persistent fever.
This study involved 65 patients with post-chemotherapy FN. It was found that high Flt3L levels (>65 pg/mL) showed a relative risk (RR) of 4.66 (95% CI 2.58 – 32.12) for the occurrence of persistent fever compared to normal/low Flt3L levels; p< 0.001. Next, high sCD14-ST levels (>100 pg/mL) had a RR of 6.58 (95% CI 2.14 – 20.19); p< 0.001. Finally, the combination of high Flt3L and sCD14ST levels showed a RR of 7.19 (95% CI 1.82 – 28.34); p< 0.001). Multivariate logistic regression analysis showed that sCD14-ST levels were independently associated with persistent fever, with an adjusted odds ratio (OR) of 8.09 (95% CI 1.76–37.11), p = 0.007. Flt3L levels were not independently associated with fever resolution, with an adjusted OR of 1.09 (95% CI 0.15–8.02), p = 0.933.
High Flt3L and sCD14-ST levels can be used to predict the risk of infectious complications, such as persistent fever, in febrile neutropenic patients post-chemotherapy. Risk stratification is crucial in determining the need for care and adjusting antibiotic therapy in FN patients.
This examination was led by the Vice Dean for General Affairs and Finance, Faculty of Medicine, Udayana University, Prof. Dr. dr. I Made Muliarta, S.Ked., M.Kes., with the following examiners:
1. Prof. Dr. dr. Ketut Suega, Sp.PD., KHOM (Promoter)
2. Prof. Dr. Dr. I Wayan Putu Sutirta Yasa, M.Si (Copromotor I)
3. Prof. Dr. Dr. Sianny Herawati, Sp.PK., Subsp.BDKT(K)., Subsp.NR(K) (Copromotor II)
4. Prof. Dr. Dr. I Made Jawi, M. Kes
5. Prof. Dr. Dr. Urged Made Wihandani, M.Kes
6. Prof. Dr. Dr. Putu Anda Tusta Adiputra, Sp.B.Subsp.Onk(K)
7.Dr. Dr. Ida Sri Iswari, Sp.MK., M.Kes
8.Dr. Dr. I Nyoman Wande, S.Ked., Sp.PK(K)
9. dr. I Wayan Sumardika, S.Ked., M.Med.Ed., Ph.D.
By academic invitation:
1. Dr. dr. Made Agus Hendrayana, M.Ked.
2. Dr. dr. I Nyoman Gede Wardana, S.Ked., M.Biomed.
3. Dr. dr. I Gusti Ngurah Bagus Artana, Sp.PD-KP
4. Dr. dr. I Gusti Agung Gede Utara Hartawan, Sp.An-TI., MARS., SH
5. Dr. dr. I Gusti Ngurah Mahaalit Aribawa, Sp.An-TI., Subsp.An.R.(K), FIP
In this examination, Dr. dr. Ngakan Ketut Wira Suastika, M.Biomed., Sp.PD., KHOM., was declared the 480th Doctoral Graduate of the Biomedical Sciences Doctoral Study Program, Faculty of Medicine, Udayana University, with Cum Laude honors.
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