A proposed score for predicting severe infection complications in children with chemotherapy-induced febrile neutropenia
A proposed score for predicting severe infection complications in children with chemotherapy-induced febrile neutropenia
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DOI：
10.1097/01.mph.0000212996.94929.0b
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发表时间：
2006-10-01
影响因子：
1.2
通讯作者：
de Camargo, Beatriz
中科院分区：
文献类型：
--
作者：
Porto Rondinelli, Patricia Imperatriz;Braga Ribeiro, Karina de Cassia;de Camargo, Beatriz
背景：发热性中性粒细胞减少症（FN）是癌症患者化疗期间最常见的并发症之一。在发热和中性粒细胞减少入院时确定与严重感染并发症（SICs）相关的因素对于更好地治疗是必要的。程序：我们修改了2000年1月至2003年12月期间所有18岁以下首次出现FN发作的患者的病历。定义了SIC的标准。这些包括菌血症或真菌血症、败血症、感染性休克和/或感染死亡。为了确定SIC与首次FN发作相关的危险因素。结果:单因素分析确定的因素为女性、年龄小于5岁、急性髓性白血病、基线疾病活动性、使用中心静脉导管、血红蛋白水平< 7 g/dL、白细胞计数< 500 cells/mm(3)、粒细胞计数< 500 cells/mm(3)、单核细胞计数< 100 cells/mm(3)、血小板计数< 20,000、体温bb0 38.5℃、化疗间隔< 7天、有无粘膜炎、肺炎、无上呼吸道感染、或者首次体检是否有临床重点。在多变量分析中，年龄小于5岁、使用中心静脉导管、体温低于38.5℃、血红蛋白水平< 7 g/dL、首次检查时是否有感染的临床重点以及没有上呼吸道感染仍是SIC的独立预测危险因素。FN人群被分为以下3个不同的风险组：I组（低风险），2组（中风险），SIC风险为13倍（4.4至38.3）；3组（高风险）SIC风险为50倍（16.4 - 149.2）。结论：本研究表明，FN患者可以根据入院时的临床参数对SIC风险进行分层。
Background: Febrile neutropenia (FN) is one of most common complications in patients with cancer during chemotherapy. Identifying factors associated with severe infectious complications (SICs) at time of admission for fever and neutropenia is necessary for better treatment.Procedure: We revised all medical charts of patients under 18 years old who developed a first episode of FN present from January 2000 to December 2003. Criteria for a SIC were defined. These included the presence of bacteremia or fungemia, sepsis, septic shock, and/or death from infection. To identify risk factors SIC was associated with the first FN episode.Results: Factors identified in univariate analysis were female sex, age less than 5 years old, acute myeloid leukemia, baseline disease activity, use of central venous catheter, hemoglobin level < 7 g/dL, leukocytes count < 500cellS/mm(3), granulocytes count < 500 cells/mm(3), monocytes count < 100 cells/mm(3), platelets < 20,000, and body temperature > 38.5 degrees C, a chemotherapy interval < 7 days, presence of mucositis, pneumonia, absence of upper respiratory tract infection, or the presence of any clinical focus on first physical examination. In multivariate analysis the variables that remained as independent predictive risk factors for SIC were age less than 5 years, use of central venous catheter, body temperature > 38.5 degrees C, hemoglobin level < 7 g/dL, any clinical focus of infection on first examination and absence of upper respiratory tract infection. The FN population was than divided among 3 different risk groups as follows: group I (low risk), group 2 (intermediate risk), with a 13 (4.4 to 38.3)-fold risk for SIC; and group 3 (high risk) with a 50 (16.4 to 149.2)-fold risk for SIC.Conclusions: This study suggests that patients with FN can be stratified for risk of SIC using clinical parameters at hospital admission.