A prospective, multicentric scoring system to predict mortality in febrile neutropenic children with cancer.
BACKGROUND
Many studies have succeeded in identifying a subset of children with febrile neutropenia (FN) who are at lower risk of infectious complications and eventual death. Conversely, to the authors' knowledge, no scoring system has been published to date with which to assess the risk of mortality for the whole group of children with neutropenia and fever.


METHODS
Between March 2000 and July 2004, 1520 episodes of FN in 981 children were included in a multicentric prospective study to evaluate a scoring system that was designed to identify high mortality risk at the onset of an FN episode in children with cancer.


RESULTS
In the derivation set (714 episodes), 18 patients died (2.5%). A multivariate analysis yielded the following significant mortality-related risk factors: advanced stage of underlying malignant disease (odds ratio [OR], 3122.1; 95% confidence interval [95% CI], 0.0001-5.2), associated comorbidity (OR, 25.3; 95% CI, 7.7-83.2), and bacteremia (OR, 7.2; 95% CI, 2.4-22.0). A mortality score could be built with 3 points scored for the presence of advanced-stage underlying malignant disease, 2 points scored for the presence of associated comorbidity, and 1 point scored for bacteremia. If patients collected 4 points of the risk score at onset, then their risk of mortality was 5.8%; if patients had a score of 5 points, then their risk of mortality was 15.4%; and, if they reached the maximum score of 6 points, then their risk of mortality was raised to 40%. The sensitivity of the scoring system was 100%, and it had a specificity of 84.2%. In the validation set (806 episodes), 19 children died (2.3%). For children with scores >3, the scoring system had a sensitivity of 84.2%, a specificity of 83.2%, and a negative predictive value of 99.54% for predicting mortality.


CONCLUSIONS
The use of a mortality score for high-risk patients was validated statistically by the current results. This is a major prognostic approach to categorize patients with high-risk FN at onset. A better initial predictive approach may allow better therapeutic decisions for these children, with an eventual impact on reducing mortality.
Paganini
Hugo R
HR
Department of Infectious Diseases, Professor Dr. Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina. hpaganini@yahoo.com.ar
Aguirre
Clarisa
C
Puppa
Gabriela
G
Garbini
Cecilia
C
Ruiz Guiñazú
Javier
J
Ensinck
Gabriela
G
Vrátnica
Claudia
C
Flynn
Luis
L
Iacono
Marisa
M
Zubizarreta
Pedro
P
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality*; D009503:Neutropenia / Q000188:drug therapy / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents