Emory University School of Medicine, Atlanta, Georgia.
Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Pediatr Blood Cancer. 2020 Nov;67(11):e28570. doi: 10.1002/pbc.28570. Epub 2020 Sep 2.
Polymerase chain reaction (PCR) respiratory viral panel (RVP) testing is often used in evaluation of pediatric cancer patients with febrile neutropenia (FN), but correlation with adverse outcomes has not been well characterized.
A retrospective cohort of all children ages 0-21 years with cancer admitted to Children's Healthcare of Atlanta for FN from January 2013 to June 2016 was identified. Patient demographic and clinical variables such as age, RVP results, length of stay (LOS), and deaths were abstracted. Relationship between RVP testing and positivity and LOS, highest temperature (Tmax), hypotension and intensive care unit (ICU) admission were compared using Wilcoxon rank sums, chi-square, or Fisher's exact tests adjusting for age, sex, bacteremia, and diagnosis.
The 404 patients identified had 787 total FN admissions. RVPs were sent in 38% of admissions and were positive in 59%. Patients with RVPs sent were younger (median 5.5 vs 8.0 years, P < .0001) with higher Tmax (39.2° vs 39.1°, P = .016). The most common virus identified was rhinovirus/Enterovirus (61%). There were no significant differences in highest temperature or lowest blood pressure based on RVP positivity. Patients admitted to the ICU were more likely to have RVPs sent (odds ratio [OR] = 3.19, P < .002); however, neither having RVP testing nor RVP positivity were significantly associated with increased LOS or death. Coinfection with bacteremia and a respiratory virus was identified in 9.1% of patients.
These data raise the question of the utility of sending potentially costly RVP testing as RVP positivity during febrile neutropenia does not impact LOS, degree of hypotension, or ICU admission.
聚合酶链反应（PCR）呼吸道病毒检测常用于评估伴有发热性中性粒细胞减少症（FN）的儿科癌症患者，但与不良结局的相关性尚未得到很好的描述。
回顾性分析了 2013 年 1 月至 2016 年 6 月期间亚特兰大儿童保健中心因 FN 入院的所有 0-21 岁癌症患儿。提取患者的人口统计学和临床变量，如年龄、RVP 结果、住院时间（LOS）和死亡。使用 Wilcoxon 秩和检验、卡方检验或 Fisher 确切检验比较 RVP 检测与阳性率和 LOS、最高体温（Tmax）、低血压和重症监护病房（ICU）入院之间的关系，同时调整年龄、性别、菌血症和诊断。
确定的 404 例患者中有 787 例 FN 入院。38%的入院患者进行了 RVP 检测，阳性率为 59%。进行 RVP 检测的患者年龄较小（中位数 5.5 岁 vs 8.0 岁，P<0.0001），Tmax 较高（39.2°C vs 39.1°C，P=0.016）。最常见的病毒是鼻病毒/肠道病毒（61%）。RVP 阳性组与阴性组之间最高体温或最低血压无显著差异。入住 ICU 的患者更有可能进行 RVP 检测（优势比[OR] = 3.19，P<0.002）；然而，进行 RVP 检测或 RVP 阳性均与 LOS 或死亡增加无关。9.1%的患者合并菌血症和呼吸道病毒感染。
这些数据提出了一个问题，即进行潜在昂贵的 RVP 检测是否有用，因为发热性中性粒细胞减少症期间的 RVP 阳性并不影响 LOS、低血压程度或 ICU 入院。
