A Scoring System To Predict Superinfections In High-Risk Febrile Neutropenic Children With Cancer
BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO(2011)
Abstract
Background. No scoring system has been published to date to assess the risk of superinfections (SI) for high-risk children with febrile neutropenia (HRFN).Methods. SI diagnoses during or 1 week after initiating antibiotic therapy in HRFN children were evaluated. Eight hundred and forty-nine episodes of febrile neutropenia (FN) were included in a prospective study to evaluate a scoring system designed to identify SI.Results. In the derivation set (566 episodes), 17% had SI. A multivariate analysis identified the following significant SI-related risk factors: acute lymphoblastic leukemia-acute myeloid leukemia (ALL-AML, OR, 1.87; 95% CI, 1.13-3.10), central venous catheter (OR, 2.11; 95% CI, 1.23-3.62), and febrile episode occurring within 10 days after chemotherapy (OR, 1.86; 95% CI, 1.09-3.15). A SI scoring system could be built: 1 point for ALL-AML, 1 point for the presence of a central venous catheter, and 1 point for the febrile episode occurring within 10 days after chemotherapy. If patients collected 3 points, then their risk of SI was 25.8%. With 2 points the risk was 16.7%, and with one minimum score of 1 point, their risk was 10.9%. The sensitivity to predict SS was 100% and its negative predictive value (NPV) was 100%. In the validation set (283 episodes), 49 (17%) children had SI. For children with scores > 0, the scoring system yielded a sensitivity of 100%, and a NPV of 100% for predicting SI.Conclusions. The use of a SI score for HRFN patients was statistically validated by these results. A better initial predictive approach may allow improved therapeutic decisions for these children.
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Key words
superinfections, secondary infections, febrile neutropenia, children, cancer
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