Development and validation of a prediction model for diagnosing blood stream infections in febrile, non-neutropenic children with cancer

Adam J. Esbenshade*, M. Cecilia Di Pentima, Zhiguo Zhao, Ayumi Shintani, Jennifer C. Esbenshade, Monique E. Simpson, Kathleen C. Montgomery, Robert B. Lindell, Haerin Lee, Ato Wallace, Kelly L. Garcia, Karel G.M. Moons, Debra L. Friedman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)

Abstract

Pediatric oncology patients are at increased risk for blood stream infections (BSI). Risk in the absence of severe neutropenia (absolute neutrophil count [ANC] ≥500/μl) is not well defined. Procedure: In a retrospective cohort of febrile (temperature ≥38.0° for >1hr or ≥38.3°) pediatric oncology patients with ANC ≥500/μl, 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.

Original languageEnglish
Pages (from-to)262-268
Number of pages7
JournalPediatric Blood and Cancer
Volume62
Issue number2
DOIs
Publication statusPublished - 1 Feb 2015

Keywords

  • Febrile neutropenia
  • Infections in immunocompromised hosts
  • Pediatric hematology/oncology
  • Prediction modeling in cancer
  • Support care

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