Risk stratification in febrile neutropenic episodes in adolescent/young adult patients with cancer.

Phillips, Robert S; Bhuller, Kaljit; Sung, Lillian; Ammann, Roland; Tissing, Wim J E; Lehrnbecher, Thomas; Stewart, Lesley A (2016). Risk stratification in febrile neutropenic episodes in adolescent/young adult patients with cancer. European journal of cancer, 64, pp. 101-106. Elsevier 10.1016/j.ejca.2016.05.027

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BACKGROUND Risk-stratified management of febrile neutropenia (FN) allows intensive management of high-risk cases and early discharge of low-risk cases. Most risk stratification systems predicting severe infection from admission variables have been derived from childhood or adult populations and consequently their value in adolescents/young adults (AYA) may vary. Our objective was to determine their value in this population. METHODS Data from the 'predicting infectious complications in children with cancer' (PICNICC) individual participant data collaboration were used to evaluate six previously described risk stratification schema in the AYA population. Complete case analyses were undertaken for five 'paediatric' rules, with imputation for specific missing variables of the 'adult' rule. The predictive performance of the rules or the outcome microbiologically defined infection (sensitivity, specificity and predictive values) were compared. RESULTS Among the 5,127 episodes of FN in 3,504 patients in the PICNICC collaboration data set, 603 episodes of FN from 478 patients in 20 studies were of patients 16-25 years old. The six rules demonstrated variable sensitivity (33-96%) and specificity (13-83%). Their overall discriminatory ability was poor (area under the receiver operator curve estimates 0.514-0.593). CONCLUSIONS Both paediatric and adult FN risk stratification schema perform poorly in AYA with cancer. An alternative rule or clinical recognition of their limitations is required.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Paediatric Haematology/Oncology

UniBE Contributor:

Ammann, Roland

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0959-8049

Publisher:

Elsevier

Language:

English

Submitter:

André Schaller

Date Deposited:

29 Mar 2017 12:59

Last Modified:

29 Mar 2017 12:59

Publisher DOI:

10.1016/j.ejca.2016.05.027

PubMed ID:

27391921

Uncontrolled Keywords:

Adolescent/young adult oncology; Infectious complications; Neutropenic sepsis; Supportive care

BORIS DOI:

10.7892/boris.93305

URI:

https://boris.unibe.ch/id/eprint/93305

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