Kanserli Çocuklarda Febril Nötropeni Risk Grubunu Belirleyen Faktörler ve Güvenli Taburculuk Süresi

Abstract

Üstün C., Variables Determining Febrile Neutropenia Risk Group of Children with Cancer and Time for Safe Discharge, Hacettepe University Faculty Of Medicine, Child Health and Diseases, Thesis, Ankara, 2019. Neutropenic fever, as one of the most common causes of hospitalization in children with cancer, is an important complication due to treatment. Individuals face different set of complications during the follow-up period of febrile neutropenia. In recent years, to facilitate a differential approach on a personal basis in terms of need for hospitalization and route for antibiotics, dividing these patients into risk groups has been proposed. Scoring systems has been created to predict the duration of antibiotic usage and hospitalization. There are limited number of studies in the pediatric patient group regarding the duration of hospital stay and the decision for safe patient discharge from hospital. The aim of this study was to investigate the effect of clinical and laboratory parameters on risk grouping and safe discharge time. Pediatric patients with lymphoma and solid tumors presented with neutopenic fever and hospitalized in the Pediatric Oncology Department of Hacettepe University Oncology Hospital between June 2018 and June 2019 were included in this study. A total of 142 neutropenic fever attacks of 88 consecutive patients were examined. Median age of the study group was 6.8 (0.4-17.4) years. Of all cases, 19.3% were lymphoma and 80.7% were solid tumors. In febrile neutropenic episodes, the median fever at the time of admission was 38.6 ° C (38-40.2) and it was over 39 °C in 31% of the patients. Febrile period duration median value was 2 (1-16) days, neutropenic period median value was 3 days (1-12) and median discharge time was 7 days (3-25). Lymphoma diagnosis (p = 0.008), presence of comorbid condition (p = 0.013), bone marrow involvement (p = 0.006), febrile neutropenic period during hospitalization (p <0.001) were associated with longer hospitalization periods. Patients with fever ≥39 °C at presentation, poor general appearance, hypotension, long capillary filling time and severe signs of infection were found to have longer hospitalization periods (p <0.001). In febrile neutropenic episodes, absolute monocyte count ≤ 100 cells / mm3 (p <0.001), platelet count ≤ 50.000 / mm3 (p = 0.046) and prolonged neutropenia (p <0.001) delayed discharge time. It was shown that group with microbiologically defined infection, especially with positive catheter cultures, was discharged later (p <0.001). Results of multivariate regression analysis shows the diagnosis of lymphoma, fever ≥ 39 ° C at admission, hypotension, presence of microbiologically defined infection, prolonged absolute neutrophil count elevation period, prolonged fever duration were the most valuable findings in determining the duration of treatment and predicting the discharge time. These parameters may help determining the risk of febrile neutropenia, predicting hospital stay and deciding safe discharge time in febrile neutropenic pediatric patients.