Santolaya María E, Alvarez Ana M, Avilés Carmen L, Becker Ana, Mosso Claudio, O'Ryan Miguel, Payá Ernesto, Salgado Carmen, Silva Pamela, Topelberg Santiago, Tordecilla Juan, Varas Mónica, Villarroel Milena, Viviani Tamara, Zubieta Marcela
Department of Pediatrics, Hospital Luis Calvo Mackennna, Santiago, Chile.
Pediatr Infect Dis J. 2007 Sep;26(9):794-8. doi: 10.1097/INF.0b013e318124aa44.
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.
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.
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).
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.
早期识别出在发热性中性粒细胞减少（FN）发作期间有死亡风险的癌症儿童，可能会增加他们的生存几率。我们的目的是在入院时识别出在FN发作期间存活或死亡的儿童之间存在显著差异的临床和实验室变量。
在一项前瞻性多中心研究中，对因高危FN发作入院的儿童在入组时进行统一评估，并根据国家共识方案进行管理。对死亡儿童的病历进行评估，以确定死亡是否与感染有关。识别出与死亡显著相关的入院临床和实验室变量。
2004年6月至2005年12月评估的561例FN发作中，共有393例（70%）被归类为侵袭性细菌感染高危，其中14例（3.6%）导致感染相关死亡。死亡发生在入院后2至27天，与存活儿童相比（分别为16%、20%和5%，P < 0.001），大多数死亡儿童入院时患有急性淋巴细胞白血病复发（36%）、低血压（71%）和脓毒症诊断（79%）。死亡儿童入院时的绝对中性粒细胞计数（P < 0.001）和绝对单核细胞计数水平较低（P = 0.008），血尿素氮（P = 0.03）和C反应蛋白值较高（P < 0.001），且培养阳性率更高（79%对32%，P = 0.008）。
我们识别出了与后期死亡显著相关的早期临床和实验室发现。对这些变量进行常规评估可能有助于早期识别有死亡风险的高危FN发作儿童。
