Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever

Purpose: To identify clinical and laboratory parameters present at the time of a first evaluation that could help predict which children with cancer, fever, and neutropenia were at high risk or low risk for an invasive bacter ial infection. Patients and Methods: Over a 17-month period, all children with cancer, fev er, and neutropenia admitted to five hospitals in Santiago, Chile, were enr olled onto a prospective protocol. Associations between admission parameter s and risk for invasive bacterial infection were assessed by univariate and logistic regression analyses. Results: A total of 447 febrile neutropenic episodes occurred in 257 childr en. Five parameters were statistically independent risk factors for an inva sive bacterial infection. Ranked by order of significance, they were as fol lows: C-reactive protein levels of 90 mg/L or higher (relative risk [RR], 4 .2; 95% confidence interval [CI], 3.6 to 4.8); presence of hypotension (RR, 2.7; 95% CI, 2.3 to 3.2); relapse of leukemia as cancer type (RR, 1.8, 95% CI, 1.7 to 2.3); platelet count less than or equal to 50,000/mm(3) (RR, 1. 7; 95% CI, 1.4 to 2.2); and recent (less than or equal to 7 days) chemother apy (RR, 1.3; 95% CI, 1.1 to 1.6). Other previously postulated risk factors (magnitude of fever, monocyte count) were not independent risk factors in this study population. Conclusion: In a large population of children, common clinical and laborato ry admission parameters were identified that can help predict the risk for an invasive bacterial infection. These results encourage the possibility of a more selective management strategy for these children. (C) 2001 by Ameri can Society of Clinical Oncology.