Sapna Oberoi1, Anirban Das1, Amita Trehan2, Pallab Ray3, Deepak Bansal1. 1. Division of Pediatric Hematology Oncology, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India. 2. Division of Pediatric Hematology Oncology, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India. trehanamita@hotmail.com. 3. Department of Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India.
Abstract
PURPOSE: Febrile neutropenia (FN) is an important cause of morbidity and mortality in children with acute lymphoblastic leukemia (ALL). We aimed to look at complications in febrile neutropenia and to derive a risk model for developing complications from the variables predicting complications. METHODS: Children on treatment for ALL, presenting with FN, were prospectively enrolled over a period of 1 year. Their clinical presentation, course during hospital stay, and outcomes were recorded. Complications recorded included septic shock, pneumonia requiring invasive or non-invasive ventilation, renal failure, neutropenic enterocolitis, encephalopathy, congestive heart failure, and bleeding manifestations. RESULTS: There were 320 episodes of FN among 176 patients. Complications occurred during 73 (22.8%) episodes. Time since last chemotherapy ≤7 days [OR 2.2 (1-4.5)], clinical focus of infection [OR 2.7 (1.3-5.5)], undernutrition [OR 2.5 (1.1-5.5)], absolute neutrophil count (ANC) ≤ 100/μL [OR 2.8 (1.3-5.9)], and C-reactive protein (CRP) > 60 mg/L at admission [OR 13.3 (5.2-33.8)] were independent predictors of complications. A risk model (total score = 13) was developed based on these predictors. Children with score of ≥7 had 17.2 (7.7-38.6) odds of developing complications as compared to those with score <7. Score of <7 predicted children at lower risk of complications [sensitivity 88% (78.2-93.8%), specificity 72.5% (65.7-78.4%), PPV 53.6% (44.3-62.6%), NPV 94.4% (89.3-97.1%)]. CONCLUSIONS: Complications during febrile neutropenia are high in a developing country setup. A risk score model based on identified risk factors can possibly help in recognizing low-risk febrile neutropenic children at admission.
PURPOSE:Febrile neutropenia (FN) is an important cause of morbidity and mortality in children with acute lymphoblastic leukemia (ALL). We aimed to look at complications in febrile neutropenia and to derive a risk model for developing complications from the variables predicting complications. METHODS:Children on treatment for ALL, presenting with FN, were prospectively enrolled over a period of 1 year. Their clinical presentation, course during hospital stay, and outcomes were recorded. Complications recorded included septic shock, pneumonia requiring invasive or non-invasive ventilation, renal failure, neutropenic enterocolitis, encephalopathy, congestive heart failure, and bleeding manifestations. RESULTS: There were 320 episodes of FN among 176 patients. Complications occurred during 73 (22.8%) episodes. Time since last chemotherapy ≤7 days [OR 2.2 (1-4.5)], clinical focus of infection [OR 2.7 (1.3-5.5)], undernutrition [OR 2.5 (1.1-5.5)], absolute neutrophil count (ANC) ≤ 100/μL [OR 2.8 (1.3-5.9)], and C-reactive protein (CRP) > 60 mg/L at admission [OR 13.3 (5.2-33.8)] were independent predictors of complications. A risk model (total score = 13) was developed based on these predictors. Children with score of ≥7 had 17.2 (7.7-38.6) odds of developing complications as compared to those with score <7. Score of <7 predicted children at lower risk of complications [sensitivity 88% (78.2-93.8%), specificity 72.5% (65.7-78.4%), PPV 53.6% (44.3-62.6%), NPV 94.4% (89.3-97.1%)]. CONCLUSIONS: Complications during febrile neutropenia are high in a developing country setup. A risk score model based on identified risk factors can possibly help in recognizing low-risk febrile neutropenicchildren at admission.
Authors: M E Santolaya; A M Alvarez; A Becker; J Cofré; N Enríquez; M O'Ryan; E Payá; J Pilorget; C Salgado; J Tordecilla; M Varas; M Villarroel; T Viviani; M Zubieta Journal: J Clin Oncol Date: 2001-07-15 Impact factor: 44.544
Authors: Alison G Freifeld; Eric J Bow; Kent A Sepkowitz; Michael J Boeckh; James I Ito; Craig A Mullen; Issam I Raad; Kenneth V Rolston; Jo-Anne H Young; John R Wingard Journal: Clin Infect Dis Date: 2011-02-15 Impact factor: 9.079
Authors: Zeina A Kanafani; Ghenwa K Dakdouki; Khalil I El-Chammas; Shaker Eid; George F Araj; Souha S Kanj Journal: Int J Infect Dis Date: 2007-03-06 Impact factor: 3.623
Authors: María E Santolaya; Ana M Alvarez; Carmen L Avilés; Ana Becker; Claudio Mosso; Miguel O'Ryan; Ernesto Payá; Carmen Salgado; Pamela Silva; Santiago Topelberg; Juan Tordecilla; Mónica Varas; Milena Villarroel; Tamara Viviani; Marcela Zubieta Journal: Pediatr Infect Dis J Date: 2007-09 Impact factor: 2.129
Authors: Ben De Pauw; Thomas J Walsh; J Peter Donnelly; David A Stevens; John E Edwards; Thierry Calandra; Peter G Pappas; Johan Maertens; Olivier Lortholary; Carol A Kauffman; David W Denning; Thomas F Patterson; Georg Maschmeyer; Jacques Bille; William E Dismukes; Raoul Herbrecht; William W Hope; Christopher C Kibbler; Bart Jan Kullberg; Kieren A Marr; Patricia Muñoz; Frank C Odds; John R Perfect; Angela Restrepo; Markus Ruhnke; Brahm H Segal; Jack D Sobel; Tania C Sorrell; Claudio Viscoli; John R Wingard; Theoklis Zaoutis; John E Bennett Journal: Clin Infect Dis Date: 2008-06-15 Impact factor: 9.079
Authors: Trijn Israëls; Marianne D van de Wetering; Peter Hesseling; Nan van Geloven; Huib N Caron; Elizabeth M Molyneux Journal: Pediatr Blood Cancer Date: 2009-07 Impact factor: 3.167