title: Prospective validation of a risk prediction model for severe sepsis in children with cancer and high-risk febrile neutropenia.
abstract: BACKGROUND
  We previously created a risk prediction model for severe sepsis not clinically apparent during the first 24 hours of hospitalization in children with high-risk febrile neutropenia (HRFN), which identified 3 variables, age ≥ 12 years, serum C-reactive protein (CRP) ≥ 90 mg/L and interleukin-8 ≥ 300 pg/mL, evaluated at the time of admission and at 24 hours of hospitalization. The combination of these 3 variables identified a risk for severe sepsis ranging from 8% to 73% with a relative risk of 3.15 (95% confidence interval: 1.1-9.06). The aim of this study was to validate prospectively our risk prediction model for severe sepsis in a new cohort of children with cancer and HRFN.
  
  
  METHODS
  Predictors of severe sepsis identified in our previous model (age, CRP and interleukin-8) were evaluated at admission and at 24 hours of hospitalization in a new cohort of children with HRFN between April 2009 and July 2011. Diagnosis of severe sepsis, not clinically apparent during the first 24 hours of hospitalization, was made after discharge by a blind evaluator.
  
  
  RESULTS
  A total of 447 HRFN episodes were studied, of which 76 (17%) had a diagnosis of severe sepsis. The combination of age ≥ 12 years, CRP ≥ 90 mg/L and interleukin-8 ≥ 300 pg/mL at admission and/or at 24 hours in the new cohort identified a risk for severe sepsis ranging from 7% to 46% with an RR of 6.7 (95% CI: 2.3-19.5).
  
  
  CONCLUSIONS
  We validated a risk prediction model for severe sepsis applicable to children with HRFN episodes within the first 24 hours of admission. We propose to incorporate this model in the initial patient assessment to offer a more selective management for children at risk for severe sepsis.
authors.affiliation: From the *Department of Pediatrics, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile; †Committee of Infectious Diseases, National Child Program of Antineoplastic Drugs (PINDA); ‡Department of Pediatrics, Hospital San Juan de Dios; §Department of Pediatrics, Hospital San Borja Arriarán, Faculty of Medicine, Universidad de Chile; ¶Department of Pediatrics, Hospital Dr. Sótero del Río; ‖Microbiology and Mycology Program, Institute of Biomedical Sciences; **Department of Pediatrics, Hospital Exequiel González Cortés; ††Department of Pediatrics, Hospital Roberto del Río; and ‡‡Center for Molecular Studies, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
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: Marcela
authors.initials: M
authors.lastname: Venegas
authors.forename: Miguel
authors.initials: M
authors.lastname: O'Ryan
authors.forename: Carmen
authors.initials: C
authors.lastname: Salgado
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
authors.forename: Verónica
authors.initials: V
authors.lastname: de la Maza
authors.forename: Alejandra
authors.initials: A
authors.lastname: Vergara
authors.forename: Mauricio J
authors.initials: MJ
authors.lastname: Farfán
authors.forename: Juan P
authors.initials: JP
authors.lastname: Torres
mesh_terms: D000293:Adolescent; D002097:C-Reactive Protein / Q000032:analysis; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D015233:Models, Statistical; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D012306:Risk; D018805:Sepsis / Q000097:blood / Q000453:epidemiology*
chemical_list: D016209:Interleukin-8; D002097:C-Reactive Protein