Esbenshade Adam J, Pentima M Cecilia Di, Zhao Zhiguo, Shintani Ayumi, Esbenshade Jennifer C, Simpson Monique E, Montgomery Kathleen C, Lindell Robert B, Lee Haerin, Wallace Ato, Garcia Kelly L, Moons Karel G M, Friedman Debra L
Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
Pediatr Blood Cancer. 2015 Feb;62(2):262-268. doi: 10.1002/pbc.25275. Epub 2014 Oct 18.
Pediatric oncology patients are at increased risk for blood stream infections (BSI). Risk in the absence of severe neutropenia (absolute neutrophil count [ANC] ≥500/µl) is not well defined.
In a retrospective cohort of febrile (temperature ≥38.0° for >1 hr or ≥38.3°) pediatric oncology patients with ANC ≥500/µl, a diagnostic prediction model for BSI was constructed using logistic regression modeling and the following candidate predictors: age, ANC, absolute monocyte count, body temperature, inpatient/outpatient presentation, sex, central venous catheter type, hypotension, chills, cancer diagnosis, stem cell transplant, upper respiratory symptoms, and exposure to cytarabine, anti-thymocyte globulin, or anti-GD2 antibody. The model was internally validated with bootstrapping methods.
Among 932 febrile episodes in 463 patients, we identified 91 cases of BSI. Independently significant predictors for BSI were higher body temperature (Odds ratio [OR] 2.36 P < 0.001), tunneled external catheter (OR 13.79 P < 0.001), peripherally inserted central catheter (OR 3.95 P = 0.005), elevated ANC (OR 1.19 P = 0.024), chills (OR 2.09 P = 0.031), and hypotension (OR 3.08 P = 0.004). Acute lymphoblastic leukemia diagnosis (OR 0.34 P = 0.026), increased age (OR 0.70 P = 0.049), and drug exposure (OR 0.08 P < 0.001) were associated with decreased risk for BSI. The risk prediction model had a C-index of 0.898; after bootstrapping adjustment for optimism, corrected C-index 0.885.
We developed a diagnostic prediction model for BSI in febrile pediatric oncology patients without severe neutropenia. External validation is warranted before use in clinical practice. Pediatr Blood Cancer 2015;62:262-268. © 2014 Wiley Periodicals, Inc.
儿科肿瘤患者发生血流感染（BSI）的风险增加。在无严重中性粒细胞减少（绝对中性粒细胞计数[ANC]≥500/µl）的情况下，其风险尚不明确。
在一组ANC≥500/µl的发热（体温≥38.0°持续>1小时或≥38.3°）儿科肿瘤患者的回顾性队列研究中，使用逻辑回归模型和以下候选预测因素构建了BSI的诊断预测模型：年龄、ANC、绝对单核细胞计数、体温、住院/门诊情况、性别、中心静脉导管类型、低血压、寒战、癌症诊断、干细胞移植、上呼吸道症状以及接触阿糖胞苷、抗胸腺细胞球蛋白或抗GD2抗体。该模型采用自抽样法进行内部验证。
在463例患者的932次发热发作中，我们确定了91例BSI病例。BSI的独立显著预测因素为体温较高（比值比[OR]2.36，P<0.001）、隧道式外置导管（OR 13.79，P<0.001）、外周静脉穿刺中心静脉导管（OR 3.95，P = 0.005）、ANC升高（OR 1.19，P = 0.024）、寒战（OR 2.09，P = 0.031）和低血压（OR 3.08，P = 0.004）。急性淋巴细胞白血病诊断（OR 0.34，P = 0.026）、年龄增加（OR 0.70，P = 0.049）和药物暴露（OR 0.08，P<0.001）与BSI风险降低相关。风险预测模型的C指数为0.898；经自抽样法校正乐观偏倚后，校正C指数为0.885。
我们为无严重中性粒细胞减少的发热儿科肿瘤患者开发了一种BSI诊断预测模型。在临床实践中使用前需进行外部验证。《儿科血液与癌症》2015年；62:262 - 268。©2014威利期刊公司。
