Predictors of Severe Sepsis Not Clinically Apparent During the First Twenty-Four Hours of Hospitalization in Children With Cancer, Neutropenia, and Fever

Santolaya, Marı́a Elena; Álvarez, Ana María Arias; Avilés, Carmen L; Becker, Ana; King, Alejandra; Mosso, Claudio; O’Ryan, Miguel; Payá, Ernesto; Salgado, Carmen; Silva, Pamela; Topelberg, Santiago; Tordecilla, Juan; Varas, Mónica; Villarroel, Milena; Viviani, Tamara; Zubieta, Marcela

doi:10.1097/inf.0b013e3181673c3c

Cited by 65 publications

(56 citation statements)

References 29 publications

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“…Other studies, however, have reported that CRP concentration was not useful in predicting bacteremia and complicated infections in cancer patients with FN [21,22]. Other biomarkers, including interleukin (IL)-6, IL-8, and procalcitonin, have been shown to be [18,[22][23][24]. Therefore, if these biomarkers are performed together with CRP, it would be more helpful to predict prognosis in FN episodes.…”

Section: Discussionmentioning

confidence: 90%

“…The predictive value of CRP concentration, however, remains unclear. Several studies have reported that CRP was a reliable predictor of severe sepsis [17][18][19][20] and correlated well with MASCC riskindex score [15]. Other studies, however, have reported that CRP concentration was not useful in predicting bacteremia and complicated infections in cancer patients with FN [21,22].…”

Section: Discussionmentioning

confidence: 96%

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Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia

Kim

Lee

Chun

et al. 2010

Support Care Cancer

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 96%

Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia

Kim

Lee

Chun

et al. 2010

Support Care Cancer

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“…This case illustrates that, by definition, risk-prediction rules are not perfect [9,18]. Since secondary deteriorations are well-known in children with FN [24,37,38], close follow-up is essential after step-down to outpatient management.…”

Section: Discussionmentioning

confidence: 93%

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Brack

Bodmer

Simon

et al. 2012

Pediatric Blood & Cancer

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BackgroundThe standard treatment of fever in chemotherapy‐induced neutropenia (FN) includes emergency hospitalization and empirical intravenous antimicrobial therapy. This study determined if first‐day step‐down to oral outpatient treatment is not inferior to continued standard regarding safety and efficacy in children with low‐risk FN.ProcedureIn a randomized controlled non‐blinded multicenter study, pediatric patients with FN after non‐myeloablative chemotherapy were reassessed after 8–22 hours of inpatient intravenous antimicrobial therapy. Low‐risk patients were randomized to first‐day step‐down to experimental (outpatient, oral amoxicillin plus ciprofloxacin) versus continued standard treatment. Exact non‐inferiority tests were used for safety (no serious medical complication; non‐inferiority margin of difference, 3.5%) and efficacy (resolution of infection without recurrence, no modification of antimicrobial therapy, no adverse event; 10%).ResultsIn 93 (26%) of 355 potentially eligible FN episodes low‐risk criteria were fulfilled, and 62 were randomized, 28 to experimental (1 lost to follow‐up) and 34 to standard treatment. In intention‐to‐treat analyses, non‐inferiority was not proven for safety [27 of 27 (100%) vs. 33 of 34 (97%; 1 death) episodes; 95% upper confidence border, 6.7%; P = 0.11], but non‐inferiority was proven for efficacy [23 of 27 (85%) vs. 26 of 34 (76%) episodes; 95% upper confidence border, 9.4%; P = 0.045]. Per‐protocol analyses confirmed these results.ConclusionsIn children with low‐risk FN, the efficacy of first‐day step‐down to oral antimicrobial therapy with amoxicillin and ciprofloxacin in an outpatient setting was non‐inferior to continued hospitalization and intravenous antimicrobial therapy. The safety of this procedure, however, was not assessable with sufficient power. Pediatr Blood Cancer 2012;59:423–430. © 2012 Wiley Periodicals, Inc.

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“…In our experience of over 936 episodes evaluated during 3 years, 25% of children admitted with a high-risk febrile neutropenia will develop sepsis and 100% of episodeassociated deaths will occur in children with diagnosis of sepsis [17 ]. Studies aimed to discriminate between children at high or low risk for sepsis are currently available [17 ,18].…”

Section: Risk For Sepsismentioning

confidence: 99%

Supportive care in children

Santolaya

2010

Current Opinion in Oncology

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In the last decades, efforts have focused on the stratification of the heterogeneous group of children with cancer and febrile neutropenia according to their risk for developing an IBI. This effort has allowed a less aggressive treatment strategy for children at low risk, including early hospital discharge and use of intravenous and oral antimicrobials at home. More recently, advances have been made in the early identification of children in the other spectrum of infection, those at high risk for sepsis and mortality, with the aim of rapid implementation of aggressive therapy.

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Predictors of Severe Sepsis Not Clinically Apparent During the First Twenty-Four Hours of Hospitalization in Children With Cancer, Neutropenia, and Fever

Abstract: Age > or =12 years and admission or 24-hour values of CRP > or =90/100 mg/L and IL-8 > or =200/300 pg/mL are predictors of sepsis not clinically apparent during the first 24 hours of hospitalization.

Cited by 65 publications

References 29 publications

Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia

Predictive factors of poor prognosis in cancer patients with chemotherapy-induced febrile neutropenia

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

Supportive care in children

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