Factors associated with adverse outcome in pediatric oncology patients with febrile neutropenia: A prospective cohort study from India.

Abstract

117 Background: Febrile neutropenia is a frequent complication in pediatric cancer patients on chemotherapy. Mortality rates from infections in this population range from 0.1-4%. Several studies from developed countries have reported the duration of fever, duration of neutropenia, comorbidities, absolute monocyte count (AMC), CRP, etc to be important predictors of a high-risk FN episode. Low medium-income countries' (LMIC) outcome data lags behind those from developed countries. Infection-associated mortality in children with febrile neutropenia is one of the major contributors to adverse outcomes. The study aims to find predictors of mortality in children with febrile neutropenia in low-income settings. Methods: A prospective cohort study of children aged 1-12 years who developed Febrile neutropenia with ongoing chemotherapy was carried out between 1st November 2019 to 31st March 2021. A comprehensive history related to demography, symptomatology, underlying disease, treatment and febrile neutropenia was documented. Study participants were followed up till the end point of the study to record outcomes. Results: A total of 131 children(mean age 6.57 years) were enrolled in the study. Of these 77.1% were males. The majority of patients had ALL (64.1 % had B cell and 20.6% had T cell ALL) followed by AML(8.4%) and Non-Hodgkin lymphoma(3.8%). The average length of hospital stay was 10 days. In-hospital mortality was 9.2%. Duration of hospitalization of more than 10 days and that of febrile neutropenia of more than a week were found to be independently associated with mortality. Absolute phagocyte counts of less than a hundred(9.1%), hemodynamic instability(29.2%), and Grade 3-4 undernutrition(8.4%) were also associated with increased mortality. Lower Absolute neutrophil count and higher procalcitonin levels on days 3 and 5 of hospitalization were also associated with patient mortality. Gender, age, baseline cancer diagnosis and infection profile during FN episode did not affect patient outcome. The cycle of chemotherapy and the time since the last dose did not affect patient outcomes. Conclusions: Malnutrition, duration of hospital stay, duration of neutropenia, absolute phagocytic count, hemodynamic instability, procalcitonin, and absolute neutrophil count were independent risk factors of mortality. Overall mortality in our study was 9.1 %. In LMIC, mortality remains high due to poor hygiene, the low education level of the population, and poor socioeconomic status.