预测指标识别中低收入国家儿科肿瘤患者中高危发热性中性粒细胞减少症。

Predictive Indicators to Identify High-Risk Paediatric Febrile Neutropenia in Paediatric Oncology Patients in a Middle-Income Country.

机构信息

Paediatric Oncology Unit, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl Drive, Tygerberg, Cape Town, South Africa.

Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, University of Stellenbosch, Van der Stel building, Bosman Road Stellenbosch, Private Bag X1, Matieland, Stellenbosch, South Africa.

出版信息

J Trop Pediatr. 2018 Oct 1;64(5):395-402. doi: 10.1093/tropej/fmx082.

DOI:10.1093/tropej/fmx082

PMID:29149345

Abstract

PURPOSE

To validate a clinical risk prediction score (Ammann score) to predict adverse events (AEs) in paediatric febrile neutropenia (FN).

PATIENTS AND METHODS

Patients <16 years of age were enrolled. A risk prediction score (based on haemoglobin ≥ 9 g/dl, white cell count (WCC) < 0.3 G/l, platelet count <50 G/l and chemotherapy more intensive than acute lymphoblastic leukaemia maintenance therapy) was calculated and AEs were documented.

RESULTS

In total, 100 FN episodes occurred in 52 patients, male:female ratio was 1.8:1 and median age was 56 months. At reassessment, AEs occurred in 18 of 55 (45%) low-risk FN episodes (score < 9) and 21 of 42 (55%) high-risk episodes (score ≥9) (sensitivity 60%, specificity 65%, positive predictive value 53%, negative predictive value 71%). Total WCC and absolute monocyte count (AMC) were significantly associated with AEs.

CONCLUSION

This study identified total WCC and AMC as significantly associated with AEs but failed to validate the risk prediction score.

摘要

目的

验证一种临床风险预测评分（Ammann 评分），以预测儿科发热性中性粒细胞减少症（FN）的不良事件（AE）。

患者和方法

纳入年龄<16 岁的患者。计算风险预测评分（基于血红蛋白≥9 g/dl、白细胞计数（WCC）<0.3 G/l、血小板计数<50 G/l 和化疗强度高于急性淋巴细胞白血病维持治疗），并记录 AE。

结果

共有 52 例患者发生 100 例 FN 发作，男：女比例为 1.8：1，中位年龄为 56 个月。在重新评估时，55 例低风险 FN 发作（评分<9）中有 18 例（45%）发生 AE，42 例高风险发作（评分≥9）中有 21 例（55%）发生 AE（敏感性 60%，特异性 65%，阳性预测值 53%，阴性预测值 71%）。总 WCC 和绝对单核细胞计数（AMC）与 AE 显著相关。