Aviles-Robles et al reported predictors of bacteremia or septic shock in a child with febrile neutropenia following chemotherapy. These can help to identify a patient who may require more aggressive management. The authors are from Hospital Infantil de Mexico Federico Gomez in Mexico City and University of Notre Dame.
Patient selection: age < 18 years old with febrile neutropenia (absolute neutrophil count < 500 per µL) following chemotherapy.
Predictors:
(1) hematologic malignancy (OR 4.15)
(2) cancer relapse (OR 2.72)
(3) older age (OR 1.08)
(4) platelet count (OR 1.00, beta coefficient -0.000006)
where:
• Thrombocytopenia can be seen in sepsis.
• Median platelet count 32,200 per µL in patients with bacteremia.
• Indwelling intravascular catheters were not used frequently. This could be a risk factor at sites where catheters are frequently used.
• The median age for patients with sepsis was 10.1 vs 7.3 for patients without sepsis).
• Other studies identified history of febrile neutropenia, intensive chemotherapy, malnutrition, serum CRP > 90 mg/dL, and time < 7 days from last chemotherapy as additional factors to consider.
A model based on these factors had an area under the ROC curve of 0.66, with sensitivity of 0.96 and specificity of 0.33.
