Anirban Das1, Amita Trehan2, Deepak Bansal1. 1. Paediatric Haematology/Oncology Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2. Paediatric Haematology/Oncology Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Correspondence to: Dr Amita Trehan, Professor and Head, Haematology-Oncology Unit, Department of Paediatrics, Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India. trehanamita@hotmail.com.
Abstract
OBJECTIVE: To analyze the risk factors for microbiologically documented infection, mortality and hospital stay more than 5 days in children with febrile neutropenia. DESIGN: Cross-sectional study (July 2013-September 2014). SETTING: Government-run, tertiary-care, university hospital in Chandigarh, Northern India. PARTICIPANTS: 414 episodes in 264 children aged <12 years, not undergoing stem-cell transplantation. OUTCOME MEASURES: Predictors for 'high-risk' febrile neutropenia. RESULTS: Microbiologically-documented infections were observed in 82 children (19.8%); bacterial 14.2%, fungal 4.3%, polymicrobial 9.7%. Complications were documented in 109 (26%) children. 43 (10.3%) died: 8 due to fungal and 35 due to bacterial sepsis. Children admitted within 7 days of the last chemotherapy (P<0.01) and having a non-upper respiratory focus of infection (P<0.02) were at risk of developing microbiologically-documented infections and death. Platelet count <20000/uL (P=0.03) was an additional predictor for microbiologically-documented infections, while albumin <2.5 g/dL (P=0.04) and C-reactive protein >90 mg/L (P=0.02) were risk factors predicting mortality. The median (IQR) duration of hospital stay was 5 (3,8) days. Hospital stay <5 days was seen in 144 (35%) children. Children with acute myeloid leukaemia (P<0.01) and admitted within 7 days of chemotherapy (P=0.02) were likely to have a prolonged hospital stay >5 days. CONCLUSIONS: Febrile neutropenic children admitted within 7 days of completion of chemotherapy, those with a non-upper respiratory focus of infection, CRP >90 mg/dL, platelet <20000/uL and albumin <2.5 g/dL need to be considered as 'high risk' for complications and mortality.
OBJECTIVE: To analyze the risk factors for microbiologically documented infection, mortality and hospital stay more than 5 days in children with febrile neutropenia. DESIGN: Cross-sectional study (July 2013-September 2014). SETTING: Government-run, tertiary-care, university hospital in Chandigarh, Northern India. PARTICIPANTS: 414 episodes in 264 children aged <12 years, not undergoing stem-cell transplantation. OUTCOME MEASURES: Predictors for 'high-risk' febrile neutropenia. RESULTS: Microbiologically-documented infections were observed in 82 children (19.8%); bacterial 14.2%, fungal 4.3%, polymicrobial 9.7%. Complications were documented in 109 (26%) children. 43 (10.3%) died: 8 due to fungal and 35 due to bacterial sepsis. Children admitted within 7 days of the last chemotherapy (P<0.01) and having a non-upper respiratory focus of infection (P<0.02) were at risk of developing microbiologically-documented infections and death. Platelet count <20000/uL (P=0.03) was an additional predictor for microbiologically-documented infections, while albumin <2.5 g/dL (P=0.04) and C-reactive protein >90 mg/L (P=0.02) were risk factors predicting mortality. The median (IQR) duration of hospital stay was 5 (3,8) days. Hospital stay <5 days was seen in 144 (35%) children. Children with acute myeloid leukaemia (P<0.01) and admitted within 7 days of chemotherapy (P=0.02) were likely to have a prolonged hospital stay >5 days. CONCLUSIONS:Febrile neutropenicchildren admitted within 7 days of completion of chemotherapy, those with a non-upper respiratory focus of infection, CRP >90 mg/dL, platelet <20000/uL and albumin <2.5 g/dL need to be considered as 'high risk' for complications and mortality.