title: Evaluation of malnutrition as a predictor of adverse outcomes in febrile neutropenia associated with paediatric haematological malignancies.
abstract: OBJECTIVE
  Malnutrition has been reported in the literature to be adversely associated with outcomes in paediatric malignancies. Our objective in this paper was to evaluate malnutrition as a potential predictor for adverse outcomes in febrile neutropenia associated with haematological malignancies.
  
  
  METHODS
  A prospective observational study was performed in a tertiary care teaching hospital of Kolkata, India. Forty-eight participants, suffering from haematological malignancy, were included. Participants were included if they experienced at least one episode of febrile neutropenia. For children aged <5 years, weight for height, height for age and weight for age were used as criteria for defining malnutrition, while body mass index for age was used in children ≥5 years. A total of 162 episodes of febrile neutropenia were studied.
  
  
  RESULTS
  Thirty patients (30/48, 62.5%) included in the study had malnutrition. In bivariate analyses at patient level, there is a strong association between malnutrition and death (odds ratio (OR) 7.286, 95% confidence interval (CI) 0.838-63.345, one-tailed P = 0.044), and life-threatening complications show a moderate trend towards significance (OR 3.333, 95% CI 0.791-14.052, one-tailed P = 0.084). Survival functions were significantly different between malnourished and non-malnourished children (log rank test χ(2)  = 4.609, degree of freedom = 1, P = 0.032). Wasting was associated with life-threatening complications in children aged <5 years (OR 14, 95% CI 1.135-172.642, one-tailed P = 0.036). Logistic regression analyses at episode level revealed that phase of treatment and respiratory system involvement were significant predictors of death, while malnutrition was not.
  
  
  CONCLUSIONS
  Malnutrition may be a potential predictor of mortality in febrile neutropenia.
authors.affiliation: Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India.
authors.forename: Jasodhara
authors.initials: J
authors.lastname: Chaudhuri
authors.affiliation: Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India.
authors.forename: Tamoghna
authors.initials: T
authors.lastname: Biswas
authors.affiliation: Department of Pediatric Medicine, KPC Medical College and Hospital, Kolkata, India.
authors.forename: Jyotishka
authors.initials: J
authors.lastname: Datta
authors.affiliation: Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India.
authors.forename: Tapas Kumar
authors.initials: TK
authors.lastname: Sabui
authors.affiliation: Department of Pediatric Medicine, Tripura Medical College and Dr BR Ambedkar Memorial Teaching Hospital, Agartala, Tripura, India.
authors.forename: Sukanta
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India.
authors.forename: Somosri
authors.initials: S
authors.lastname: Ray
authors.affiliation: Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India.
authors.forename: Dibyendu
authors.initials: D
authors.lastname: Raychaudhuri
authors.affiliation: Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India.
authors.forename: Kalyanbrata
authors.initials: K
authors.lastname: Mandal
authors.affiliation: Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India.
authors.forename: Kaushani
authors.initials: K
authors.lastname: Chatterjee
authors.affiliation: Department of Statistical Science, Duke University and Statistical and Applied Mathematical Sciences Institute, Durham, North Carolina, United States.
authors.forename: Swapna
authors.initials: S
authors.lastname: Chakraborty
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever; D005544:Forecasting; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D044342:Malnutrition; D009503:Neutropenia / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D011446:Prospective Studies
keywords: malignancy; malnutrition; neutropenia