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Prospective Validation of a Risk Prediction Model for Severe Sepsis in Children With Cancer and High-risk Febrile Neutropenia

Santolaya, María E. MD*†; Alvarez, Ana M. MD†‡; Avilés, Carmen L. MD†§; Becker, Ana MD†¶; Venegas, Marcela MD†§; O’Ryan, Miguel MD; Salgado, Carmen MD†**; Topelberg, Santiago MD†††; Tordecilla, Juan MD†††; Varas, Mónica MD†‡; Villarroel, Milena MD*†; Viviani, Tamara MD†¶; Zubieta, Marcela MD†**; de la Maza, Verónica RN*; Vergara, Alejandra MT‡‡; Farfán, Mauricio J. PhD‡‡; Torres, Juan P. PhD*

Pediatric Infectious Disease Journal:
doi: 10.1097/01.inf.0000436128.49972.16
Original Studies
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.

Author Information

From the *Department of Pediatrics, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile; Committee of Infectious Diseases, National Child Program of Antineoplastic Drugs (PINDA); Department of Pediatrics, Hospital San Juan de Dios; §Department of Pediatrics, Hospital San Borja Arriarán, Faculty of Medicine, Universidad de Chile; Department of Pediatrics, Hospital Dr. Sótero del Río; Microbiology and Mycology Program, Institute of Biomedical Sciences; **Department of Pediatrics, Hospital Exequiel González Cortés; ††Department of Pediatrics, Hospital Roberto del Río; and ‡‡Center for Molecular Studies, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile.

Accepted for publication June 14, 2013.

Supported by FONDECYT, grant 1090194.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: María Elena Santolaya, MD, Atalaya 11152, Las Condes, Santiago, Chile. E-mail: msantola@med.uchile.cl.

© 2013 by Lippincott Williams & Wilkins, Inc.