Neutropenic Enterocolitis in Adult Hematopoietic Stem Cell Transplant Recipients: Clinical characteristics and Prognostic Significance of Clinical Findings and Bowel Wall Thickening

Objective: To present the clinical characteristics of HSCT recipients that developed NE at our institution and assess the prognostic value of clinical and radiological findings in HSCT recipients with a NE diagnosis.;Methods: Clinical records from 264 consecutive HSCT recipients over a six-year period (2004-2010) were reviewed. Twenty-four patients with a diagnosis of NE based on the clinical triad of fever, abdominal pain and neutropenia (ANC < 500/mm3) along with radiographic evidence of colonic wall thickening were identified. Degree of colonic wall thickness detected by CT scan (classified as mild > 2-5 mm, moderate 6-11 mm and severe >12 mm) along with clinical characteristics were evaluated and correlated with clinical outcomes (complicated vs. non-complicated NE) and NE related mortality. Complicated NE cases were defined as those patients who died as the direct result of enterocolitis complications, required vasopressor support in the intensive-care setting or developed enteric flora bacteremia as the result of NE.;Results: 264 patients underwent a HSCT 2004 to 2010, and twenty four patients (9.1%) were diagnosed with NE. The most common transplant indication was relapsed/refractory non-Hodgkin lymphoma. Median bowel thickness was 6 mm per CT criteria, degree of thickness was distributed as follows: 11 cases were mild, 9 moderate, and 3 patients were considered to have severe thickening. Three patients died as a direct result of neutropenic enterocolitis complications and eleven patients were classified as complicated. Age, gender, type of transplant, underlying diagnosis, presence of or number of co-morbidities and length of neutropenia had no impact on morbidity or mortality in our patient population. Degree of bowel thickening failed to impact mortality on univariate analysis (dead vs. alive: > 3 mm p=0.25, > 6 mm p=0.48, > 12 mm p=1.00). The presence of moderate and severe thickening (> 6 mm) was associated with significant morbidity and a higher rate of complicated enterocolitis (complicated vs. uncomplicated: > 6 mm p=0.003 OR:30.0, 95 % CI 2.6-342.7) A mucosal thickness of > 6 mm was found to be highly predictive of a complicated course on multivariate analysis as well (p=0.009 OR:31.5 [2.35-422.3]).;Conclusion: Neutropenic enterocolitis is a severe and not uncommon complication in HSCT recipients, with an incidence of 9% and a mortality of 12%. Clinical characteristics had no prognostic impact on mortality and clinical outcomes in HSCT recipients with NE, but patients with moderate or severe bowel thickening have a worse clinical outcome. Larger studies and development of standardized criteria for bowel thickness measurement are warranted to validate these findings in future studies.