Role of Hematological Parameters, Biochemical Markers, and Pharmacological Management in Febrile Neutropenia in Kidney Cancer Patients Undergoing Chemotherapy

Abstract

Background & Objective: Febrile neutropenia (FN) is a life-threatening oncological emergency that poses severe risks to kidney cancer patients who often present with compromised baseline renal reserve. This study aimed to systematically evaluate the predictive role of specific hematological parameters and biochemical markers, and assess the patterns and clinical outcomes of pharmacological management in kidney cancer patients presenting with chemotherapy-induced FN.

Material and Methods: An observational cross-sectional study was conducted across tertiary oncology and nephrology units over a 12-month period. A total of n = 220 adult renal cell carcinoma (RCC) patients presenting with chemotherapy-induced FN were enrolled via consecutive sampling. Complete blood counts, inflammatory biomarkers (Procalcitonin [PCT], C-Reactive Protein [CRP]), renal panels (creatinine, eGFR), and pharmacological interventions (broad-spectrum antimicrobials, G-CSF) were recorded at FN onset. Univariate, multivariable logistic regression, and ROC curve analyses evaluated biological predictors of complicated outcomes (septic shock, acute kidney injury [AKI], or 30-day mortality).

Results: Complicated FN occurred in 27.3% (n = 60) of participants. Patients in the complicated group demonstrated significantly lower absolute neutrophil counts (ANC: 245.3 ± 88.1 vs. 382.6 ± 102.4 cells/µL, p < 0.001) and elevated Neutrophil-to-Lymphocyte Ratios (NLR: 11.8 ± 3.4 vs. 5.6 ± 1.8, p < 0.001). Serum Procalcitonin was dramatically higher in complicated cases (median: 4.85 vs. 0.42 ng/mL, p < 0.001). Acute kidney injury developed in 22.7% (n = 50) of the overall cohort. Multivariable logistic regression identified PCT > 2.0 ng/mL (aOR = 5.42, 95% CI: 2.31–12.72, p < 0.001), eGFR < 45 mL/min/1.73m² (aOR = 4.15, p < 0.001), NLR > 8.5 (aOR = 3.88, p = 0.001), and ANC < 200 cells/µL (aOR = 3.12, p = 0.008) as independent predictors of adverse outcomes. PCT demonstrated the highest diagnostic accuracy for predicting septic shock/AKI (AUC = 0.912). Renal dose modifications for antimicrobials were required in 41.8% of cases.

Conclusion: Chemotherapy-induced febrile neutropenia in kidney cancer patients carries a high risk of life-threatening complications driven by severe neutropenia, acute inflammation, and impaired renal reserve. Dynamic monitoring of PCT and NLR provides superior risk stratification. Standardized management requires immediate empirical parenteral antibiotics paired with G-CSF support and rigorous real-time renal antimicrobial dose adjustment.

Keywords: Febrile Neutropenia, Renal Cell Carcinoma, Procalcitonin, Neutrophil-to-Lymphocyte Ratio, Acute Kidney Injury, Pharmacological Management, G-CSF.