Children with cancer, fever, and treatment-induced neutropenia: risk factors associated with illness requiring the administration of critical care therapies.
OBJECTIVE
To identify clinical and laboratory characteristics of pediatric patients with cancer, fever, and treatment-induced neutropenia, available at existing at initial presentation, that are independently associated with the development of illnesses requiring administration of critical care therapies.


METHODS
We retrospectively collected historical, clinical, and laboratory data on initial presentation for all pediatric (younger than 18 years) cancer patients admitted for fever and treatment-induced neutropenia at our institution over a 5-year period. The outcome variable was the need for administration of a critical care therapy within 24 hours of admission. A multivariable analysis was performed and internally validated using bootstrap analysis.


RESULTS
We identified 303 events in 143 patients, of which 36 (11.9%) received a critical care therapy. Higher temperature at presentation and capillary filling time (CFT) of >3 seconds retained significance in the multivariable analysis and were validated by the bootstrap analysis. The positive and negative predictive values of the presence of either temperature of > or =39.5 degrees C or CFT of >3 seconds were 35% and 91%, respectively.


CONCLUSIONS
Pediatric patients with cancer, fever, and treatment-induced neutropenia who present with higher fever or prolonged CFT are at increased risk of developing life-threatening illnesses requiring administration of critical care therapies, independent of hematologic factors, type of cancer, or other physiologic signs of sepsis.
West
Daniel C
DC
*Section of Hematology/Oncology, School of Medicine, University of California, Davis, CA; †Department of Pediatrics and Center for Health Services Research in Primary Care, School of Medicine, University of California, Davis, CA; ‡Section of Critical Care Medicine, School of Medicine, University of California, Davis, CA.
Marcin
James P
JP
Mawis
Roland
R
He
Jingsong
J
Nagle
Audrey
A
Dimand
Robert
R
D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors