Introduction: Despite a low bacteremia rate, pediatric oncology patients are frequently admitted for febrile neutropenia. A pediatric risk prediction model with high sensitivity to identify patients at low risk for bacteremia is not available. We performed a single-institution prospective cohort study of pediatric oncology patients with febrile neutropenia to create a risk prediction model using clinical factors, respiratory viral infection, and cytokine expression.
Materials and Methods: Pediatric oncology patients with febrile neutropenia were enrolled between March 30, 2010 and April 1, 2011 and managed per institutional protocol. Blood samples for C-reactive protein and cytokine expression and nasopharyngeal swabs for respiratory viral testing were obtained. Medical records were reviewed for clinical data. Statistical analysis utilized mixed multiple logistic regression modeling.
Results: During the 12-month period, 195 febrile neutropenia episodes were enrolled. There were 24 (12%) episodes of bacteremia. Univariate analysis revealed several factors predictive for bacteremia, and interleukin (IL)-8 was the most predictive variable in the multivariate stepwise logistic regression. Low serum IL-8 predicted patients at low risk for bacteremia with a sensitivity of 0.9 and negative predictive value of 0.98.
Conclusions: IL-8 is a highly sensitive predictor for patients at low risk for bacteremia. IL-8 should be utilized in a multi-institution prospective trial to assign risk stratification to pediatric patients admitted with febrile neutropenia.
*Department of Pediatrics, Division of Hematology and Oncology, University of Texas Southwestern Medical Center
†Department of Clinical Sciences, University of Texas Southwestern Medical Center and Children’s Medical Center, Dallas, TX
The authors declare no conflict of interest.
Supported by Children’s Cancer Fund of Dallas.
Reprints: Carrye R. Cost, MD, Department of Pediatrics, Division of Oncology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Mail Location R7015, Cincinnati, OH 45229-3039 (e-mail: firstname.lastname@example.org).
Received February 14, 2012
Accepted December 6, 2012