Osama K Mobaireek1, Nesrin A Al-Harthy2, Abdulrhman M Alnasser1, Jinan R Al-Rashoud1, Mohammed H Hommady1, Winnie Philip3, Shoeb Qureshi3
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia.
2Department of Paediatric Emergency, King Abdullah Specialist Children Hospital and College of Applied Medical Sciences (M&F), Riyadh, Saudi Arabia.
3Department of Research, College of Applied Medical Sciences, Riyadh, Saudi Arabia.
Objectives: The aim is to clinically validate prediction model for risk of complications in pediatric cancer patients with febrile neutropenia (FN). Materials and Methods: A risk prediction model for pediatric patients with FN is previously published (Hakim et al. model). In this retrospective, cross-sectional study, we validated the model’s prediction of proven invasive infection and culture-negative sepsis on 108 patients, aged 14 years or younger, who developed FN in outpatient settings, and were admitted to King Abdulaziz Medical City in Riyadh, Saudi Arabia between January 1, 2006 and December 31, 2015. Patients’ charts were reviewed, and the predicted versus observed outcomes were recorded. For the clinical prediction model validation, odds ratios, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated. Results: Patients’ ages ranged from 4 months to 13.5 years (median: 5.7 years). Sixty-two percent of patients had acute lymphoblastic leukemia or lymphoma, 33% had solid tumors, and 5% had acute myeloid leukemia. Clinical complications were identified in 38% of patients including positive cultures in 7%. In our population, the model’s sensitivity was 27%, specificity was 75%, PPV was 39%, and NPV was 63%. Univariate analysis showed no statistically significant correlation between outcome and gender, clinical appearance, temperature, absolute neutrophil count, or cancer classification. Conclusion: Risk of FN complications could not be reliably predicted in our population using the previously published risk prediction model (Hakim et al. model). Moreover, none of the clinical variables could reliably classify patients. Hence, clinical practice needs to treat all FN patients with caution of high-risk complications.
Keywords: Cancer, Chemotherapy, Sepsis.