Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Center for Outcomes Research, JPS Health Network, Fort Worth, Texas.
Pediatr Blood Cancer. 2018 Apr;65(4). doi: 10.1002/pbc.26935. Epub 2017 Dec 29.
The Predicting Infectious Complications in Neutropenic Children and Young People with Cancer (PICNICC) model was recently developed for antibiotic stewardship among pediatric cancer patients, but limited information is available about its clinical usefulness. We aimed to assess the performance of the PICNICC model for predicting microbiologically documented bacterial infections among pediatric cancer patients with febrile neutropenia.
We used data for febrile neutropenia episodes at a pediatric cancer center in Aarhus, Denmark between 2000 and 2016. We assessed the area under the receiver operating characteristic curve (AUC), calibration, and clinical usefulness (i.e., net benefit). We also recalibrated the model using statistical updating methods.
We observed 306 microbiologically documented bacterial infections among 1,892 episodes of febrile neutropenia. The AUC of the model was 0.73 (95% confidence limits [CL]: 0.71-0.75). The calibration intercept (calibration-in-the-large) was -0.69 (95% CL: -0.86 to -0.51) and the slope was 0.77 (95% CL: 0.65-0.89). Modest net benefit was observed at a decision threshold of 5%. Recalibration improved calibration but did not improve net benefit.
The PICNICC model has potential for reducing unnecessary antibiotic exposure for pediatric cancer patients with febrile neutropenia, but continued validation and refinement is necessary to optimize clinical usefulness.
最近开发了一种用于儿科癌症患者抗生素管理的预测中性粒细胞减少儿童和青少年感染并发症（PICNICC）模型，但关于其临床实用性的信息有限。我们旨在评估 PICNICC 模型在预测发热性中性粒细胞减少症儿科癌症患者中微生物学证实的细菌感染方面的性能。
我们使用了丹麦奥胡斯一家儿科癌症中心 2000 年至 2016 年发热性中性粒细胞减少症发作的数据。我们评估了接收者操作特征曲线（AUC）、校准和临床有用性（即净收益）的面积。我们还使用统计更新方法重新校准了该模型。
我们观察到 1892 例发热性中性粒细胞减少症发作中有 306 例微生物学证实的细菌感染。该模型的 AUC 为 0.73（95%置信区间[CL]：0.71-0.75）。校准截距（大范围校准）为-0.69（95%CL：-0.86 至-0.51），斜率为 0.77（95%CL：0.65-0.89）。在决策阈值为 5%时观察到适度的净收益。重新校准虽然改善了校准，但并未提高净收益。
PICNICC 模型有可能减少发热性中性粒细胞减少症儿科癌症患者不必要的抗生素暴露，但需要进一步验证和改进以优化临床实用性。
