Systematic Reviews
Copyright ©The Author(s) 2016.
World J Gastroenterol. Jul 7, 2016; 22(25): 5853-5866
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5853
Table 1 Different definitions of neutropenic enterocolitisamong studies
Neutropenic enterocolitis definitionNeutropenia (Neutrophil count/mm3)Abnormal bowel wall thickness thresholds (imaging technique)Ref.
Neutropenia in addition to fever and abdominal pain (generalized or localized to right lower quadrant) without any other obvious cause of abdominal discomfort< 500Not specifiedJain et al[26], 2000
Al least 1 suggestive clinical sign (fever, abdominal tenderness, diarrhea, nausea, emesis, abdominal pain, and/or constipation) associated with bowel wall thickness ≥ 0.3 cm< 500≥ 0.3 cm (either CT or US; CT and US findings were significantly different)McCarville et al[42], 2005
Abdominal pain, fever, and neutropenia associated with radiological abnormalities in the terminal ileum and/or ascending colon (comprising increased wall thickness, pericecal edema, pneumatosis intestinalis)< 1000Not specified (CT)Hobson et al[51], 2005
Recent abdominal pain (global or right lower quadrant), fever and severe neutropenia in absence of prior abdominal discomfort< 500> 5 mm (US and CT)Alioglu et al[24], 2007
One or more of clinical signs (fever, abdominal pain, diarrhea, abdominal tenderness, nausea, emesis, and/or evidence of peritonitis) and one or more imaging findings on US, CT, x-ray (bowel wall thickening, bowel edema, relative paucity of bowel gas, bowel mass, thumb printing of the mucosa or air in the bowel wall)< 500Not specified (x-ray or US or CT)Moran et al[54], 2009
Clinical triad (abdominal pain, fever and neutropenia) or 2 clinical features with thickened bowel wall in imaging< 1.65Not specified (US or CT)Mullassery et al[23], 2009
1 or more signs and/or symptoms related to the effects of treatment (abdominal pain, abdominal distention, vomiting, diarrhea, fever defined as TC ≥ 38 °C, gastrointestinal bleeding, or obstipation) associated with increased intestinal wall thickness in US ≤ 500≥ 3 mm (US)Rizzatti et al[22], 2010
Clinical triad (abdominal pain, high fever and neutropenia) associated with the evidence of image signs (thickened bowel wall) by abdominal US or CT scan< 500> 4 mm (US or CT)Li et al[40], 2011
Fever (TC > 38.5 °C), abdominal pain, neutropenia associated with radiologically confirmed thickening of the bowel wall< 500> 3 mm (CT and US concordant)Sundell et al[38], 2012
Clinical triad (abdominal pain, fever and neutropenia) or 2 clinical features with thickened bowel wall in imaging< 500> 5 mm (US/CT)Altinel et al[39], 2012
Proposed diagnostic criteria:Sachak et al[175], 2015
Major criteria
Compatible histology
At least borderline neutropenia
Gastrointestinal symptoms
Recent chemotherapy
Exclusion of other treatable etiologies
Minor criteria
Fever of > 38 °C
Bowel wall thickening of > 4 mm over > 30 mm
Positive microbiologic studies
“Definitive” NE satisfies the major criteria
Table 2 Clinical, laboratory and imaging factors associated with severe neutropenic enterocolitis
Previous therapy with cytarabineHigher death rateRizzatti et al[22], 2010
Age > 16 yrWorse response to medical therapyMcCarville et al[42], 2005
Presence of abdominal distentionHigher risk of deathRizzatti et al[22], 2010
Presence of abdominal tendernessProlonged durationMcCarville et al[42], 2005
Presence of feverProlonged durationMcCarville et al[42], 2005
4 or more symptoms of enterocolitisHigher risk of deathRizzatti et al[22], 2010
Severe (absolute neutrophil count < 108/L) or prolonged (> 7 d) neutropeniaDisease progressionJain et al[26], 2000
Duration of neutropeniaProlonged durationMcCarville et al[42], 2005
Increased serum Interleukin-8 levels on the first day of clinical illnessHigher risk of admission in Intensive Care Unitvan de Wetering et al[55], 2008
Bowel wall ticknessProlonged durationSundell et al[38], 2012
Higher mortality rateCartoni et al[57], 2001
Higher death rateRizzatti et al[22], 2010
Prolonged durationMcCarville et al[42], 2005
Appendiceal thickeningHigher risk of serious complicationsMcCarville et al[56], 2004