Risk Factors Associated With Life-threatening Infections in Children With Febrile Neutropenia

Badiei, Zahra; Khalesi, Maryam; Alami, M. H.; Kianifar, Hamidreza; Banihashem, Abdollah; Farhangi, Hamid; Razavi, Amir Reza

doi:10.1097/mph.0b013e3181f6921a

Cited by 30 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Apart from younger age, bivariate analysis identified an association of mucositis with FN and MDI: Higher grades of mucositis correlated with more FN episodes and higher infection rates. These findings are in concordance with the results of other studies that found associations of mucositis with FN [8,38] and severe infections [39] in bivariate analysis. Indeed, mucositis is the result of a complex series of biological events involving inflammation, alteration of the local tissue response, apoptosis of the basal cell layer and loss of mucosal integrity that facilitates migration of mucosal microorganisms and makes the individual prone to invasive bacterial, fungal and viral infection [40][41][42][43][44].…”

Section: Discussionsupporting

confidence: 93%

Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma

Willmer

Zöllner

Schaumburg

et al. 2021

Cancers

View full text Add to dashboard Cite

The purpose of this retrospective, single-center cohort study was to assess the infectious burden in pediatric sarcoma patients during neoadjuvant chemotherapy. The review included all patients with a new diagnosis of Ewing sarcoma, osteosarcoma or soft tissue sarcoma between September 2009 and December 2018 who were enrolled in the EWING 2008, CWS SoTiSaR and EURAMOS clinical trial or registry. Primary endpoints were the occurrence of febrile neutropenia (FN) and microbiologically documented infection (MDI). Parameters with a potential impact on FN and MDI were also analyzed. A total of 170 sarcoma patients (median age: 13 years, range: 0–21; 96 m/74 f) received 948 chemotherapy courses (median: 6; range: 2–8). Of these patients, 58.8% had ≥1 FN episode and 20.6% ≥ 1 MDI. FN occurred in 272/948 courses (28.7%) with fever of unknown origin (FUO) in 231 courses and 45 MDI and 19 clinically documented infections (CDI) occurring in a total of 57 courses. Patients enrolled in EWING 2008 had significantly more FN (p < 0.001), infections (p = 0.02) and MDI (p = 0.035). No infection-related deaths were observed. Younger age, tumor type and localization, and higher median and maximum mucositis grades were significantly associated with higher numbers of FN (p < 0.001), and younger age (p = 0.024) and higher median mucositis grade (p = 0.017) with MDI. The study shows substantial infectious morbidity in sarcoma patients during neoadjuvant chemotherapy treatment and opportunities to improve prevention and management.

show abstract

Section: Discussionsupporting

confidence: 93%

Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma

Willmer

Zöllner

Schaumburg

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…Four studies examined rules to predict significant medical complications; a group of outcomes generally encompassing death, intensive care admission, significant bacterial or fungal infection, and need for organ support such as supplemental oxygen, inotropes or dialysis [7], [14], [16], [17]. Two examined rules to predict bacteraemia [16], [18], and one intensive care admission [15].…”

Section: Resultsmentioning

confidence: 99%

Updated Systematic Review and Meta-Analysis of the Performance of Risk Prediction Rules in Children and Young People with Febrile Neutropenia

et al. 2012

View full text Add to dashboard Cite

IntroductionFebrile neutropenia is a common and potentially life-threatening complication of treatment for childhood cancer, which has increasingly been subject to targeted treatment based on clinical risk stratification. Our previous meta-analysis demonstrated 16 rules had been described and 2 of them subject to validation in more than one study. We aimed to advance our knowledge of evidence on the discriminatory ability and predictive accuracy of such risk stratification clinical decision rules (CDR) for children and young people with cancer by updating our systematic review.MethodsThe review was conducted in accordance with Centre for Reviews and Dissemination methods, searching multiple electronic databases, using two independent reviewers, formal critical appraisal with QUADAS and meta-analysis with random effects models where appropriate. It was registered with PROSPERO: CRD42011001685.ResultsWe found 9 new publications describing a further 7 new CDR, and validations of 7 rules. Six CDR have now been subject to testing across more than two data sets. Most validations demonstrated the rule to be less efficient than when initially proposed; geographical differences appeared to be one explanation for this.ConclusionThe use of clinical decision rules will require local validation before widespread use. Considerable uncertainty remains over the most effective rule to use in each population, and an ongoing individual-patient-data meta-analysis should develop and test a more reliable CDR to improve stratification and optimise therapy. Despite current challenges, we believe it will be possible to define an internationally effective CDR to harmonise the treatment of children with febrile neutropenia.

show abstract

“…Besides the 5 clinical decision rules (CDR) mentioned above [2]–[4],[6],[7], only 3 of 13 further recently reviewed [5],[20] studies generating CDRs for pediatric FN reported non-significant univariate associations of hemoglobin with different AE [21]–[23]. Since hemoglobin is routinely assessed at presentation with FN, this may well represent underreporting of negative results.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Association of Hemoglobin Level and Adverse Events in Children with Cancer Presenting with Fever in Neutropenia

et al. 2014

View full text Add to dashboard Cite

BackgroundIn children and adolescents with fever in neutropenia (FN) during chemotherapy for cancer, hemoglobin ≥90 g/L at presentation with FN had been associated with adverse events (AE). This analysis explored three hypothetical pathophysiological mechanisms potentially explaining this counterintuitive finding, and further analyzed the statistical association between hemoglobin and AE.MethodsTwo of 8 centers, reporting on 311 of 421 FN episodes in 138 of 215 patients participated in this retrospective analysis based on prospectively collected data from three databases (SPOG 2003 FN, transfusion and hematology laboratories). Associations with AE were analyzed using mixed logistic regression.ResultsHemoglobin was ≥90 g/L in 141 (45%) of 311 FN episodes, specifically in 59/103 (57%) episodes with AE, and in 82/208 (39%) without (OR, 2.3; 99%CI, 1.1–4.9; P = 0.004). In FN with AE, hemoglobin was bimodally distributed with a dip around 85 g/L. There were no significant interactions for center, age and sex. In multivariate mixed logistic regression, AE was significantly and independently associated with leukopenia (leukocytes <0.3 G/L; OR, 3.3; 99%CI, 1.1–99; P = 0.004), dehydration (hemoglobinPresentation/hemoglobin8–72 hours ≥1.10 in untransfused patients; OR, 3.5; 99%CI, 1.1–11.4; P = 0.006) and non-moderate anemia (difference from 85 g/L; 1.6 per 10 g/L; 1.0–2.6; P = 0.005), but not with recent transfusion of packed red blood cells (pRBC), very recent transfusion of pRBC or platelets, or with hemoglobin ≥90 g/L as such.ConclusionsNon-moderate anemia and dehydration were significantly and relevantly associated with the risk of AE in children with cancer and FN. These results need validation in prospective cohorts before clinical implementation.

show abstract

Risk Factors Associated With Life-threatening Infections in Children With Febrile Neutropenia

Abstract: Evaluation of important RFs and judging the severity of patients' condition by studying the importance and relationship between RF at the time of admission can be a useful method for screening LTI in children with FN.

Cited by 30 publications

References 18 publications

Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma

Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma

Updated Systematic Review and Meta-Analysis of the Performance of Risk Prediction Rules in Children and Young People with Febrile Neutropenia

Exploring the Association of Hemoglobin Level and Adverse Events in Children with Cancer Presenting with Fever in Neutropenia

Contact Info

Product

Resources

About