Prospective Validation of a Risk Prediction Model for Severe Sepsis in Children With Cancer and High-risk Febrile Neutropenia
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Santolaya de Pablo, María Elena
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Prospective Validation of a Risk Prediction Model for Severe Sepsis in Children With Cancer and High-risk Febrile Neutropenia
Author
- Santolaya de Pablo, María Elena;
- Alvarez, Ana M.;
- Avilés, Carmen L.;
- Becker, Ana;
- Venegas, Marcela;
- O'Ryan Gallardo, Miguel;
- Salgado, Carmen;
- Topelberg, Santiago;
- Tordecilla, Juan;
- Varas, Mónica;
- Villarroel, Milena;
- Viviani, Tamara;
- Zubieta, Marcela;
- Maza León, Verónica de la;
- Vergara, Alejandra;
- Farfán, Mauricio J.;
- Torres Torretti, Juan Pablo;
Abstract
Background: We previously created a risk prediction model for severe sepsis
not clinically apparent during the first 24 hours of hospitalization in children
with high-risk febrile neutropenia (HRFN), which identified 3 variables, age
≥12 years, serum C-reactive protein (CRP) ≥90 mg/L and interleukin-8 ≥300
pg/mL, evaluated at the time of admission and at 24 hours of hospitalization.
The combination of these 3 variables identified a risk for severe sepsis ranging
from 8% to 73% with a relative risk of 3.15 (95% confidence interval: 1.1–
9.06). The aim of this study was to validate prospectively our risk prediction
model for severe sepsis in a new cohort of children with cancer and HRFN.
Methods: Predictors of severe sepsis identified in our previous model (age,
CRP and interleukin-8) were evaluated at admission and at 24 hours of hospitalization
in a new cohort of children with HRFN between April 2009 and
July 2011. Diagnosis of severe sepsis, not clinically apparent during the first
24 hours of hospitalization, was made after discharge by a blind evaluator.
Results: A total of 447 HRFN episodes were studied, of which 76 (17%)
had a diagnosis of severe sepsis. The combination of age ≥12 years, CRP
≥90 mg/L and interleukin-8 ≥300 pg/mL at admission and/or at 24 hours in
the new cohort identified a risk for severe sepsis ranging from 7% to 46%
with an RR of 6.7 (95% CI: 2.3–19.5).
Conclusions: We validated a risk prediction model for severe sepsis applicable
to children with HRFN episodes within the first 24 hours of admission.
We propose to incorporate this model in the initial patient assessment
to offer a more selective management for children at risk for severe sepsis.
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Pediatr Infect Dis J 2013;32:1318–1323
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