Predictive Factors for Duration of Fever in Neutropenic Febrile Episodes in Children with Cancer

Abstract

Background: Febrile neutropenia (FN) is one of the most important complications in pediatric oncology. The present study aimed to determine the predictive factors of fever duration in Iranian pediatric patients with FN. Methods: This cross-sectional study was conducted on episodes of FN in children with cancer undergoing chemotherapy, admitted to the hospital with an oral temperature ≥ 38.3°C or at least two readings of oral temperature ≥ 38°C within one hour, and an absolute neutrophil count (ANC) ≤ 1500/µL at the time of admission. All children were treated according to our routine protocol for the management of FN. Potential predictive factors were recorded at the time of admission. The time of defervescence was considered the outcome variable. Ordinal regression analysis was used to determine the independent factors that could significantly predict the duration of fever in febrile neutropenic episodes. Results: One hundred and eighty FN episodes in children with cancer (53.3% boys, 46.7% girls, mean age 5.48 ± 3.44 years) were included in our study. Independent predictive factors were the severity of neutropenia (P = 0.01), patients’ general condition (P = 0.02), higher temperature ≥ 39°C (P = 0.006), higher serum C-reactive protein (CRP) > 90 (P = 0.04), positive central catheter culture (P = 0.00), and having at least one positive culture (P = 0.005). Conclusions: We conclude that the severity of neutropenia, patients' poor general condition, higher temperature, higher serum CRP, and having at least one positive blood, urine, or central catheter culture are significant predictors of the duration of fever in FN episodes.