| Abstract | dc.description.abstract | Purpose: To identify clinical and laboratory parameters
present at the time of a first evaluation that could
help predict which children with cancer, fever, and
neutropenia were at high risk or low risk for an invasive
bacterial infection.
Patients and Methods: Over a 17-month period, all
children with cancer, fever, and neutropenia admitted
to five hospitals in Santiago, Chile, were enrolled
onto a prospective protocol. Associations between
admission parameters and risk for invasive bacterial
infection were assessed by univariate and logistic
regression analyses.
Results: A total of 447 febrile neutropenic episodes
occurred in 257 children. Five parameters were statistically
independent risk factors for an invasive bacterial
infection. Ranked by order of significance, they were as
follows: C-reactive protein levels of 90 mg/L or higher
(relative risk [RR], 4.2; 95% confidence interval [CI], 3.6
to 4.8); presence of hypotension (RR, 2.7; 95% CI, 2.3 to
3.2); relapse of leukemia as cancer type (RR, 1.8, 95%
CI, 1.7 to 2.3); platelet count less than or equal to
50,000/mm3 (RR, 1.7; 95% CI, 1.4 to 2.2); and recent (<
7 days) chemotherapy (RR, 1.3; 95% CI, 1.1 to 1.6).
Other previously postulated risk factors (magnitude of
fever, monocyte count) were not independent risk factors
in this study population.
Conclusion: In a large population of children, common
clinical and laboratory admission parameters
were identified that can help predict the risk for an
invasive bacterial infection. These results encourage the
possibility of a more selective management strategy for
these children. | en_US |
