title: Admission clinical and laboratory factors associated with death in children with cancer during a febrile neutropenic episode.
abstract: BACKGROUND
  Early identification of children with cancer at risk for death during a febrile neutropenic (FN) episode may increase their possibility for survival. Our aim was to identify at the time of admission, clinical and laboratory variables differing significantly among children who survived or died during a FN episode.
  
  
  METHODS
  In a prospective, multicenter study, children admitted with a high-risk FN episode were uniformly evaluated at enrollment and managed according to a national consensus protocol. Medical charts of children who died were evaluated to determine whether the death could be associated with an infection. Admission clinical and laboratory variables significantly associated with death were identified.
  
  
  RESULTS
  A total of 393 (70%) of 561 FN episodes evaluated from June 2004 to December 2005 were classified as high risk for invasive bacterial infection, of which 14 (3.6%) resulted in an infectious-related death. Deaths occurred from 2 to 27 days after admission, and most dying children were admitted with relapse of acute lymphocytic leukemia (36%), hypotension (71%), and a diagnosis of sepsis (79%), compared with surviving children (16%, 20%, and 5% respectively, P < 0.001). Children who died were admitted with lower absolute neutrophil count (P < 0.001) and absolute monocytes count levels (P = 0.008), higher blood urinary nitrogen (P = 0.03) and C-reactive protein values (P < 0.001), and had more positive cultures (79% versus 32%, P = 0.008).
  
  
  CONCLUSIONS
  We identified early clinical and laboratory findings significantly associated with death occurring at a later stage. Routine evaluation of these variables may prove to be useful in the early identification of children with a high-risk FN episode at risk for death.
authors.affiliation: Department of Pediatrics, Hospital Luis Calvo Mackennna, Santiago, Chile. msantola@med.uchile.cl
authors.forename: María E
authors.initials: ME
authors.lastname: Santolaya
authors.forename: Ana M
authors.initials: AM
authors.lastname: Alvarez
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Avilés
authors.forename: Ana
authors.initials: A
authors.lastname: Becker
authors.forename: Claudio
authors.initials: C
authors.lastname: Mosso
authors.forename: Miguel
authors.initials: M
authors.lastname: O'Ryan
authors.forename: Ernesto
authors.initials: E
authors.lastname: Payá
authors.forename: Carmen
authors.initials: C
authors.lastname: Salgado
authors.forename: Pamela
authors.initials: P
authors.lastname: Silva
authors.forename: Santiago
authors.initials: S
authors.lastname: Topelberg
authors.forename: Juan
authors.initials: J
authors.lastname: Tordecilla
authors.forename: Mónica
authors.initials: M
authors.lastname: Varas
authors.forename: Milena
authors.initials: M
authors.lastname: Villarroel
authors.forename: Tamara
authors.initials: T
authors.lastname: Viviani
authors.forename: Marcela
authors.initials: M
authors.lastname: Zubieta
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002677:Chile / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000652:urine; D009503:Neutropenia / Q000097:blood / Q000150:complications* / Q000401:mortality* / Q000652:urine; D012008:Recurrence; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000382:microbiology / Q000401:mortality*; D017741:Survivors