Department of Pediatrics, University of Bern, Bern, Switzerland.
Pediatr Infect Dis J. 2011 Jul;30(7):e114-9. doi: 10.1097/INF.0b013e318215a290.
To develop a score predicting the risk of bacteremia in cancer patients with fever and neutropenia (FN), and to evaluate its performance.
Pediatric patients with cancer presenting with FN induced by nonmyeloablative chemotherapy were observed in a prospective multicenter study. A score predicting the risk of bacteremia was developed from a multivariate mixed logistic regression model. Its cross-validated predictive performance was compared with that of published risk prediction rules.
Bacteremia was reported in 67 (16%) of 423 FN episodes. In 34 episodes (8%), bacteremia became known only after reassessment after 8 to 24 hours of inpatient management. Predicting bacteremia at reassessment was better than prediction at presentation with FN. A differential leukocyte count did not increase the predictive performance. The reassessment score predicting future bacteremia in 390 episodes without known bacteremia used the following 4 variables: hemoglobin ≥ 90 g/L at presentation (weight 3), platelet count <50 G/L (3), shaking chills (5), and other need for inpatient treatment or observation according to the treating physician (3). Applying a threshold ≥ 3, the score--simplified into a low-risk checklist--predicted bacteremia with 100% sensitivity, with 54 episodes (13%) classified as low-risk, and a specificity of 15%.
This reassessment score, simplified into a low-risk checklist of 4 routinely accessible characteristics, identifies pediatric patients with FN at risk for bacteremia. It has the potential to contribute to the reduction of use of antimicrobials in, and to shorten the length of hospital stays of pediatric patients with cancer and FN.
开发一种预测癌症伴发热和中性粒细胞减少（FN）患者发生菌血症风险的评分系统，并评估其性能。
在一项前瞻性多中心研究中，观察因非清髓性化疗导致 FN 的儿科癌症患者。从多变量混合逻辑回归模型中开发出一种预测菌血症风险的评分系统。将其交叉验证预测性能与已发表的风险预测规则进行比较。
在 423 例 FN 发作中，有 67 例（16%）报告发生菌血症。在 34 例（8%）中，仅在住院管理 8-24 小时后重新评估时才发现菌血症。与 FN 发作时相比，重新评估时预测菌血症的效果更好。白细胞分类计数并不能提高预测性能。在 390 例无已知菌血症的重新评估中，预测未来菌血症的评分使用了以下 4 个变量：就诊时血红蛋白≥90g/L（权重 3）、血小板计数<50G/L（3）、寒战（5）以及根据治疗医生需要住院治疗或观察（3）。应用≥3 的阈值，该评分（简化为低风险检查表）以 100%的敏感性预测菌血症，54 例（13%）被归类为低风险，特异性为 15%。
这种重新评估评分，简化为 4 种常规可获得的特征的低风险检查表，可以识别 FN 风险较高的儿科癌症患者。它有可能有助于减少抗生素的使用，并缩短癌症和 FN 儿科患者的住院时间。
