Oberoi Sapna, Das Anirban, Trehan Amita, Ray Pallab, Bansal Deepak
Division of Pediatric Hematology Oncology, Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India.
Department of Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India.
Support Care Cancer. 2017 Nov;25(11):3523-3528. doi: 10.1007/s00520-017-3776-7. Epub 2017 Jun 11.
Febrile neutropenia (FN) is an important cause of morbidity and mortality in children with acute lymphoblastic leukemia (ALL). We aimed to look at complications in febrile neutropenia and to derive a risk model for developing complications from the variables predicting complications.
Children on treatment for ALL, presenting with FN, were prospectively enrolled over a period of 1 year. Their clinical presentation, course during hospital stay, and outcomes were recorded. Complications recorded included septic shock, pneumonia requiring invasive or non-invasive ventilation, renal failure, neutropenic enterocolitis, encephalopathy, congestive heart failure, and bleeding manifestations.
There were 320 episodes of FN among 176 patients. Complications occurred during 73 (22.8%) episodes. Time since last chemotherapy ≤7 days [OR 2.2 (1-4.5)], clinical focus of infection [OR 2.7 (1.3-5.5)], undernutrition [OR 2.5 (1.1-5.5)], absolute neutrophil count (ANC) ≤ 100/μL [OR 2.8 (1.3-5.9)], and C-reactive protein (CRP) > 60 mg/L at admission [OR 13.3 (5.2-33.8)] were independent predictors of complications. A risk model (total score = 13) was developed based on these predictors. Children with score of ≥7 had 17.2 (7.7-38.6) odds of developing complications as compared to those with score <7. Score of <7 predicted children at lower risk of complications [sensitivity 88% (78.2-93.8%), specificity 72.5% (65.7-78.4%), PPV 53.6% (44.3-62.6%), NPV 94.4% (89.3-97.1%)].
Complications during febrile neutropenia are high in a developing country setup. A risk score model based on identified risk factors can possibly help in recognizing low-risk febrile neutropenic children at admission.
发热性中性粒细胞减少症（FN）是急性淋巴细胞白血病（ALL）患儿发病和死亡的重要原因。我们旨在研究发热性中性粒细胞减少症的并发症，并根据预测并发症的变量推导出发病并发症的风险模型。
前瞻性纳入1年内接受ALL治疗且出现FN的患儿。记录他们的临床表现、住院期间的病程及结局。记录的并发症包括感染性休克、需要有创或无创通气的肺炎、肾衰竭、中性粒细胞减少性小肠结肠炎、脑病、充血性心力衰竭和出血表现。
176例患者中发生320次FN发作。73次（22.8%）发作期间出现并发症。距上次化疗时间≤7天[比值比（OR）2.2（1 - 4.5）]、感染临床病灶[OR 2.7（1.3 - 5.5）]、营养不良[OR 2.5（1.1 - 5.5）]、绝对中性粒细胞计数（ANC）≤100/μL[OR 2.8（1.3 - 5.9）]及入院时C反应蛋白（CRP）>60 mg/L[OR 13.3（5.2 - 33.8）]是并发症的独立预测因素。基于这些预测因素建立了一个风险模型（总分=13）。与得分<7的儿童相比，得分≥7的儿童发生并发症的几率为17.2（7.7 - 38.6）。得分<7预测儿童发生并发症的风险较低[敏感性88%（78.2 - 93.8%），特异性72.5%（65.7 - 78.4%），阳性预测值53.6%（44.3 - 62.6%），阴性预测值94.4%（89.3 - 97.1%）]。
在发展中国家，发热性中性粒细胞减少症期间的并发症发生率很高。基于已确定风险因素的风险评分模型可能有助于在入院时识别低风险发热性中性粒细胞减少症患儿。
