Development and Validation of a Prediction Model for Diagnosing Blood Stream Infections in Febrile, Non-Neutropenic Children With Cancer
Development and Validation of a Prediction Model for Diagnosing Blood Stream Infections in Febrile, Non-Neutropenic Children With Cancer
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DOI：
10.1002/pbc.25275
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发表时间：
2015-02-01
影响因子：
3.2
通讯作者：
Friedman, Debra L.
中科院分区：
文献类型：
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作者：
Esbenshade, Adam J.;Di Pentima, M. Cecilia;Friedman, Debra L.
背景。儿科肿瘤患者发生血流感染（BSI）的风险增加。没有严重中性粒细胞减少（绝对中性粒细胞计数[ANC] >= 500/ μ l）的风险没有很好的定义。过程。在一组发热（>= 38.0度，> 1小时或>= 38.3度）的儿科肿瘤患者中，采用logistic回归模型和以下候选预测因子构建了BSI的诊断预测模型：年龄、ANC、绝对单核细胞计数、体温、住院/门诊表现、性别、中心静脉导管类型、低血压、寒战、癌症诊断、干细胞移植、上呼吸道症状、暴露于阿糖胞苷、抗胸腺细胞球蛋白或抗gd2抗体。采用自举方法对模型进行内部验证。结果。在463例患者的932次发热发作中，我们确定了91例BSI。BSI的独立显著预测因素是体温升高（优势比[OR] 2.36 P< 0.001）、隧道外置导管（OR 13.79 P< 0.001）、周围置管中心导管（OR 3.95 P = 0.005）、ANC升高（OR 1.19 P = 0.024）、寒战（OR 2.09 P = 0.031）和低血压（OR 3.08 P = 0.004）。急性淋巴细胞白血病诊断（OR 0.34 P = 0.026）、年龄增加（OR 0.70 P = 0.049）和药物暴露（OR 0.08 P< 0.001）与BSI风险降低相关。风险预测模型的c指数为0.898；自举调整乐观度后，修正c指数0.885。结论。我们开发了一个无严重中性粒细胞减少症的发热小儿肿瘤患者BSI的诊断预测模型。在临床应用前需要进行外部验证。(C) 2014 Wiley期刊公司
Background. Pediatric oncology patients are at increased risk for blood stream infections (BSI). Risk in the absence of severe neutropenia (absolute neutrophil count [ANC] >= 500/mu l) is not well defined. Procedure. In a retrospective cohort of febrile (temperature >= 38.0 degrees for > 1 hr or >= 38.3 degrees) pediatric oncology patients with ANC >= 500/mu l, a diagnostic prediction model for BSI was constructed using logistic regression modeling and the following candidate predictors: age, ANC, absolute monocyte count, body temperature, inpatient/outpatient presentation, sex, central venous catheter type, hypotension, chills, cancer diagnosis, stem cell transplant, upper respiratory symptoms, and exposure to cytarabine, anti-thymocyte globulin, or anti-GD2 antibody. The model was internally validated with bootstrapping methods. Results. Among 932 febrile episodes in 463 patients, we identified 91 cases of BSI. Independently significant predictors for BSI were higher body temperature (Odds ratio [OR] 2.36 P< 0.001), tunneled external catheter (OR 13.79 P< 0.001), peripherally inserted central catheter (OR 3.95 P = 0.005), elevated ANC (OR 1.19 P = 0.024), chills (OR 2.09 P = 0.031), and hypotension (OR 3.08 P = 0.004). Acute lymphoblastic leukemia diagnosis (OR 0.34 P = 0.026), increased age (OR 0.70 P = 0.049), and drug exposure (OR 0.08 P< 0.001) were associated with decreased risk for BSI. The risk prediction model had a C-index of 0.898; after bootstrapping adjustment for optimism, corrected C-index 0.885. Conclusions. We developed a diagnostic prediction model for BSI in febrile pediatric oncology patients without severe neutropenia. External validation is warranted before use in clinical practice. (C) 2014 Wiley Periodicals, Inc.