Predictors of severe adverse outcomes in febrile neutropenia of pediatric oncology patients at a single institute in Thailand

Abstract

Febrile neutropenia in pediatric oncology patients may lead to severe infection, with adverse events including septic shock or death. The aim of the study was to investigate the prevalence of severe adverse outcomes and to determine the associated risk factors. This is a retrospective cohort study of pediatric oncology patients with febrile neutropenia from October 2013 to September 2017 at Thammasat University Hospital, Thailand. Clinical assessment and time-to-event of severe outcomes were analyzed. There were 95 febrile neutropenic episodes; severe adverse outcomes were documented in 11 (11.5%), with no infection-associated mortalities. Those with severe outcomes were older, received prophylactic granulocyte-colony stimulating factor (G-CSF), and had documented infection, lower initial ANC, and central venous catheter insertion. The proportional hazard regression model revealed age ≥ 10 years (hazard ratio [HR], 5.96; p = 0.005), prophylactic G-CSF (HR, 4.52; p = 0.028), and microbiologically documented infections (HR, 12.53; p = 0.017) independently predicted severe adverse outcomes. Although severe adverse outcomes occurred in only 11.5% of our febrile neutropenic episodes, we identified a few risk factors that may help predict those at highest risk.

Keywords:

• Febrile neutropenia
• pediatric oncology
• predictor
• severe adverse outcome
• time-to-event analysis

Acknowledgments

The authors express their gratitude to patients and parents for their cooperation as well Watcharin Pothamuang, Termsook Ruksrithong and Nareomon Thongsem for their invaluable assistance. We are indebted to all clinical staff members at Department of Emergency Medicine and Department of Pediatrics, Faculty of Medicine, Thammasat University and Thammasat University Hospital, who established the clinical practice guideline and cared for these patients. We would like to thank the Center of Excellence in Applied Epidemiology for consultation. English language editing was done by Debra Kim Liwiski, international instructor, Clinical Research Center, Faculty of Medicine, Thammasat University.

Declaration of interests

All authors have no conflicts of interest to disclose. All authors have no financial relationships relevant to this article to disclose.