Also Noted

Comment Children with cancer who are admitted with fever and neutropenia (FN) are at high risk for serious infection, which can lead to severe sepsis (systemic inflammatory response and organ dysfunction) and even death. This group of authors has previously identified and validated a clinical prediction rule that can identify those at low or high risk for invasive bacterial infection. This study enrolled children with high-risk episodes of FN from 6 public hospitals in Santiago, Chile. On the basis of prior studies, the authors selected 6 biomarkers: blood urea nitrogen, serum glucose, lactic dehydrogenase, serum C-reactive protein, interleukin-8, and procalcitonin. These biomarkers were assessed at admission and at 24 hours. Six hundred one episodes of high-risk FN were identified. Of these, 25% were associated with severe sepsis, only 23% of which were clinically apparent during the first 24 hours of hospitalization. Using logistic regression, the authors evaluated the factors that were most predictive of severe sepsis. Age ≥12 years (odds ratio 3.85, 95% confidence interval 2.41-6.15) and admission or 24-hour values of C-reactive protein ≥90/100 mg/L (OR 2.03, 95% CI 1.32-3.14) and IL-8 ≥200/300 pg/mL (OR 2.39, 95% CI 1.51-3.78) are predictors of sepsis not clinically apparent during the first 24 hours of hospitalization. This is an interesting and well-done study that advances our understanding of this important condition. These factors still need to be validated in other pediatric settings. In the meantime, they could be obtained on admission for children diagnosed with fever and neutropenia.