Predictive analysis and policy recommendations for the management of malignancy-related grade 4 neutropenia emergencies in patients undergoing chemotherapy: A restrospective cohort data-based study at Sardjito Hospital

Abstract

Chemotherapy-induced grade 4 neutropenia represents a life-threatening oncologic emergency with mortality rates of 25-40% due to sepsis. This study developed a validated mortality prediction model for this condition in an Indonesian tertiary hospital. A retrospective cohort analysis of 212 patients with grade 4 neutropenia was conducted using Cox proportional hazards regression. Key mortality predictors included age over 60 years, recent platinum-based chemotherapy, and leukocyte count below 500 cells/μl. Early G-CSF administration
demonstrated a protective effect, reducing mortality risk by 40%. These findings align with contemporary research highlighting the prognostic significance of profound neutropenia and support ASCO guidelines recommending early growth factor administration. The prediction model shows clinical utility for real-time
risk stratification in emergency settings, enabling timely interventions. Study limitations include its retrospective design and single-center data, necessitating multicenter validation. This research provides critical evidence for enhanced monitoring protocols, protocolized G-CSF use, and clinical decision support systems to improve patient outcomes.