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Case-control study to evaluate risk factors for the development of sepsis (neutropenia and fever) in dogs receiving chemotherapy

Karin U. SorenmoDepartment of Clinical Studies, School of Veterinary Medicine, Philadelphia, PA 19104
Mari Lowe Center for Comparative Oncology, School of Veterinary Medicine, Philadelphia, PA 19104

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Lisa P. HarwoodDepartment of Clinical Studies, School of Veterinary Medicine, Philadelphia, PA 19104

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Lesley G. KingDepartment of Clinical Studies, School of Veterinary Medicine, Philadelphia, PA 19104

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Kenneth J. DrobatzDepartment of Clinical Studies, School of Veterinary Medicine, Philadelphia, PA 19104

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Abstract

Objective—To identify risk factors for development of sepsis in dogs treated with chemotherapeutics and to evaluate the impact of sepsis on outcome.

Design—Case-control study.

Animals—Client-owned dogs with various cancers undergoing standard chemotherapeutic treatment at the University of Pennsylvania veterinary hospital.

Procedures—39 dogs with sepsis (cases) were identified through a search of the medical record database. Controls (n = 77) were randomly selected from dogs admitted during the same time period. Variables analyzed included patient demographics, tumor type, stage, remission status, treatment phase, chemotherapeutics used, and outcome.

Results—Dogs that weighed less and dogs with lymphoma were significantly more likely to become septic, compared with larger dogs or dogs with solid tumors. Septic dogs were also significantly more likely to have received doxorubicin (odds ratio [OR], 12.5; 95% confidence interval [CI], 2.4 to 66.0) or vincristine (OR, 9.0; 95% CI, 1.6 to 52.0) than controls. Of the 39 cases, 28 (71.8%) were in the induction phase of their protocol, and 19 of 39 (48.7%) became septic after receiving the chemotherapeutic drug for the first time. Median survival time of the cases (253 days) was not significantly different from that of the controls (371 days).

Conclusions and Clinical Relevance—Dogs that weighed less were at increased risk for chemotherapy-induced sepsis. Tumor type and chemotherapeutic drug used were also important risk factors. These results may lead to the implementation of prophylactic measures, especially when doxorubicin or vincristine is used in the induction phase in small dogs with lymphoma.

Abstract

Objective—To identify risk factors for development of sepsis in dogs treated with chemotherapeutics and to evaluate the impact of sepsis on outcome.

Design—Case-control study.

Animals—Client-owned dogs with various cancers undergoing standard chemotherapeutic treatment at the University of Pennsylvania veterinary hospital.

Procedures—39 dogs with sepsis (cases) were identified through a search of the medical record database. Controls (n = 77) were randomly selected from dogs admitted during the same time period. Variables analyzed included patient demographics, tumor type, stage, remission status, treatment phase, chemotherapeutics used, and outcome.

Results—Dogs that weighed less and dogs with lymphoma were significantly more likely to become septic, compared with larger dogs or dogs with solid tumors. Septic dogs were also significantly more likely to have received doxorubicin (odds ratio [OR], 12.5; 95% confidence interval [CI], 2.4 to 66.0) or vincristine (OR, 9.0; 95% CI, 1.6 to 52.0) than controls. Of the 39 cases, 28 (71.8%) were in the induction phase of their protocol, and 19 of 39 (48.7%) became septic after receiving the chemotherapeutic drug for the first time. Median survival time of the cases (253 days) was not significantly different from that of the controls (371 days).

Conclusions and Clinical Relevance—Dogs that weighed less were at increased risk for chemotherapy-induced sepsis. Tumor type and chemotherapeutic drug used were also important risk factors. These results may lead to the implementation of prophylactic measures, especially when doxorubicin or vincristine is used in the induction phase in small dogs with lymphoma.

Contributor Notes

Dr. Harwood's present address is Paoli Vetcare, 1476 E Lancaster Ave, Paoli, PA 19301.

Address correspondence to Dr. Sorenmo (karins@vet.upenn.edu).