Risk Prediction in Pediatric Cancer Patients With Fever and Neutropenia

Department of Infectious Diseases, Mail Stop 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA.
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 12/2009; 29(1):53-59. DOI: 10.1097/INF.0b013e3181c3f6f0
Source: PubMed


Background: To identify predictors for 2 risk measures—“proven invasive bacterial infection or culture-negative sepsis (IBD)” and “clinical complications (CC)”—in pediatric cancer patients with fever and neutropenia (FN).
Methods: Records of 390 patients with FN hospitalized over 2 years were reviewed. For the 332 who met inclusion criteria, one FN episode was randomly selected. Independent predictors at presentation were analyzed using multiple regression models. Optimal cut-off risk prediction scores were determined. These models were validated by bootstrap analysis.
Results: Patients' median age was 6.0 years; 66% had an underlying diagnosis of leukemia. Independent predictors of IBD (n = 56) were absolute neutrophil count <100, temperature at presentation ≥39.0°C, “sick” clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <24 reliably identified patients at low risk for IBD. Independent predictors of CC (n = 47) were relapse of malignancy, non-white race, “sick” clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <19 predicted patients at low risk for CC. Of those misclassified as low risk, 11 of 12 with IBD and 3 of 9 with CC had the outcome within 24 hours of presentation. Of the remaining patients classified as low-risk for IBD and CC, 99.5% and 97.1%, respectively, remained outcome-free after 24 hours of observation.
Conclusions: This study identifies predictors of infection/complications in pediatric patients with FN, establishes clinical cut-off scores and highlights the importance of the initial clinical impression and 24 hours of observation. These prediction models warrant prospective validation.

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    • "Five studies attempted to derive at least one CDR. Four studies examined rules to predict significant medical complications; a group of outcomes generally encompassing death, intensive care admission, significant bacterial or fungal infection, and need for organ support such as supplemental oxygen, inotropes or dialysis [7], [14], [16], [17]. Two examined rules to predict bacteraemia [16], [18], and one intensive care admission [15]. "
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