Validation of Risk Scale in Febrile Neutropenic Patients with Cancer in Guatemala

Abstract

Abstract Background In National Unit of Pediatric Oncology (UNOP) located in Guatemala City an average of 150 patients are treated per day in outpatient and emergency consultation. The episodes of neutropenia post chemotherapy were recognized as predisposing factors for infections. Methods Prospective analytical observational study of pediatric cancer patients with episodes of febrile neutropenia, attended at the National Pediatric Oncology Unit (UNOP) in Guatemala. The following inclusion criteria apply: Patients age under 18 years old and diagnosis of cancer and febrile neutropenia defined by temperature above 38.3 C, ANC ≤ 500 secondary to chemotherapy in the past 7 days. Exclusion criteria apply patients with fever and neutropenia but not received chemotherapy and patients with an infectious focus. The primary endpoint was evaluated the performance of the risk categorization scale in febrile neutropenic patients. Secondary end points were admission to paediatric intensive care unit, death, reactive protein C value (CRP) and bacterial infection. Results A total of 28 episodes of fever and neutropenia recruited between November 2021 and July 2022 were classified 14 (50%) in low risk and 14 (50%) in high risk. Blood cultures were positive in 5 patients (17.9%). The risk scale was not statistically significative to predict bacteremia because two low risk patients have positive blood cultures, X2 was 0.243 (p=0.622) RR 0.917 95% CI (0.648 – 1.30). The majority of pathogens (4/5) were Gram- negative. Admission at intensive care unit in patients with high risk was statistically not significant x2 1.17 (p = 0.280). The calculated relative risk is 3.01 95% CI (0.621-1.15) without any deaths. According to the risk classification CRP ≥ 90 mg/L at 72 hours was 21.4% and 64.3% in patients with low and high risk respectively, X2 5.25 (p = 0.022). Conclusion The scale performance in the study was not statistically significative to predict bacteriemia in patients with febrile neutropenia, however it was clinically relevant to predict admission at unit intensive care for high risk patients. The early detection of a bacteremia and the rapid therapeutic intervention are crucial to improve the outcome