Risk prediction in pediatric cancer patients with fever and neutropenia.
BACKGROUND
To identify predictors for 2 risk measures-"proven invasive bacterial infection or culture-negative sepsis (IBD)" and "clinical complications (CC)"-in pediatric cancer patients with fever and neutropenia (FN).


METHODS
Records of 390 patients with FN hospitalized over 2 years were reviewed. For the 332 who met inclusion criteria, one FN episode was randomly selected. Independent predictors at presentation were analyzed using multiple regression models. Optimal cut-off risk prediction scores were determined. These models were validated by bootstrap analysis.


RESULTS
Patients' median age was 6.0 years; 66% had an underlying diagnosis of leukemia. Independent predictors of IBD (n = 56) were absolute neutrophil count <100, temperature at presentation > or =39.0 degrees C, "sick" clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <24 reliably identified patients at low risk for IBD. Independent predictors of CC (n = 47) were relapse of malignancy, non-white race, "sick" clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <19 predicted patients at low risk for CC. Of those misclassified as low risk, 11 of 12 with IBD and 3 of 9 with CC had the outcome within 24 hours of presentation. Of the remaining patients classified as low-risk for IBD and CC, 99.5% and 97.1%, respectively, remained outcome-free after 24 hours of observation.


CONCLUSIONS
This study identifies predictors of infection/complications in pediatric patients with FN, establishes clinical cut-off scores and highlights the importance of the initial clinical impression and 24 hours of observation. These prediction models warrant prospective validation.
Hakim
Hana
H
Department of Infectious Diseases, Mail Stop 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA. Hana.Hakim@stjude.org
Flynn
Patricia M
PM
Srivastava
Deo Kumar
DK
Knapp
Katherine M
KM
Li
Chenghong
C
Okuma
James
J
Gaur
Aditya H
AH
D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000209:etiology*; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis* / Q000473:pathology*