Survival and Mortality-Associated Factors in Febrile Neutropenia Among Patients with Malignancy Receiving Empirical Ceftazidime

Abstract

Febrile neutropenia is a serious complication of cancer therapy that may rapidly progress to severe infection and death. Evidence on survival determinants among patients receiving empirical ceftazidime in Indonesia remains limited. This study evaluated survival and examined the associations of absolute neutrophil count (ANC), age, and cancer type with mortality. This single-centre retrospective cohort study included adults with cancer and febrile neutropenia admitted to Dr Wahidin Sudirohusodo Hospital, Makassar, between January 2025 and April 2026. Survival was evaluated using Kaplan-Meier analysis and the log-rank test, and factors associated with mortality were assessed using Cox proportional hazards regression. Among 90 patients, 78.9% had haematological malignancies and 25.6% had an ANC <100 cells/µL. During follow-up, 19 patients (21.1%) died. Survival was significantly lower in patients with an ANC <100 cells/µL than in those with an ANC of 100-500 cells/µL (log-rank p<0.001), while no significant differences were observed by cancer type or age group. In multivariable analysis, an ANC <100 cells/µL (aHR 5.84, 95% CI 2.17-15.78; p<0.001) and age ≥60 years (aHR 3.08, 95% CI 1.03-9.20; p=0.044) were independently associated with a higher hazard of death. Severe neutropenia and older age may help identify patients requiring closer clinical monitoring.