scholarly journals Serum Lactate: A Predictor of Septic Shock in Childhood Cancers with Febrile Neutropenia

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110227
Author(s):  
Detchvijitr Suwanpakdee ◽  
Warakorn Prasertsin ◽  
Chanchai Traivaree ◽  
Piya Rujkijyanont
Keyword(s):  
Septic Shock ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Roc Curve ◽  
Surrogate Marker ◽  
Serum Lactate ◽  
P Value ◽  
Oncology Patients ◽  
Baseline Serum ◽  
Significant Difference

Early recognition and management are the key elements to prevent febrile neutropenia associated mortality. The prospective observational study aimed to investigate prognostic accuracy of serum lactate to predict septic shock within 48 hours among hemodynamically stable children with febrile neutropenia. In all, 99 pediatric oncology patients who developed febrile neutropenia were enrolled in the study. Clinical information during 48 hours and serum lactate at the time of enrollment were analyzed. Among 99 participating patients, 10 developed septic shock and 4 of those expired. No significant difference was found of patients’ baseline characteristics and basic laboratory parameters between patients with and without septic shock. Serum lactate was significantly elevated among patients developing septic shock ( P-value < .001) and those who expired ( P-value .002). Receiver operating characteristic (ROC) curve was created to identify the best cutoff value for initial serum lactate associated with the development of septic shock within 48 hours. Baseline serum lactate more than 2.5 mmol/L showed the largest area under the ROC curve to predict the septic shock development within 48 hours (ROC area, 0.90; 95% confidence interval [CI], 0.81-0.98), with sensitivity, specificity, negative predictive value, and accuracy of 80.0%, 92.1%, 97.6%, and 90.9%, respectively. Serum lactate level determined early at the time of febrile neutropenia was an effective surrogate marker for developing septic shock within 48 hours among hemodynamically stable, pediatric oncology patients. The level more than 2.5 mmol/L was the best threshold to start preemptive aggressive hemodynamic monitoring and prompt treatment to ensure adequate tissue perfusion.

#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S16
Author(s):  
Miguel A Minero ◽  
Asia Castro ◽  
Martha Avilés-Robles
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

#35: Safety of Early Hospital Discharge of Neutropenic Pediatric Oncology Patients After Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Asia Castro ◽  
Miguel Minero ◽  
Martha Avilés-Robles
Keyword(s):  
Septic Shock ◽  
Febrile Neutropenia ◽  
Hospital Discharge ◽  
Antibiotic Treatment ◽  
Pediatric Oncology ◽  
Early Discharge ◽  
Infectious Complications ◽  
Oncology Patients ◽  
Early Hospital Discharge ◽  
The Mean

Abstract Background Cancer is one of the leading causes of death in children in Mexico. Infections are the main cause of morbidity and mortality in these patients. Febrile neutropenia (FN) constitutes an infectious emergency and early aggressive antibiotic treatment is the standard of care. Recent guidelines suggest discontinuing empirical antibiotics in patients who have negative blood cultures at 48 hours, who have been afebrile for at least 24 hours, and who have evidence of marrow recovery. Nevertheless, recommendations about discontinuing antibiotics and discharging patients while they are still neutropenic are less clear. We aimed to evaluate the safety of early hospital discharge of FN patients who are still neutropenic. Methods Observational, case–control study nested in a prospective cohort of pediatric oncology patients with FN at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from May 2015 to September 2017. We defined early discharge as when a patient is discharged while neutropenic (ANC &lt;500 cell/mm3) and has completed at least 7 days of antibiotics. Patients with FN who were discharged with neutropenia were defined as cases and patients with FN who were discharged after recovering from neutropenia were controls. To assess the safety of hospital early discharge, the following outcomes were analyzed until 7 days after discharge: new onset of fever, hospital readmission, need to restart antibiotic treatment, septic shock, and death. Descriptive statistics were performed with measures of central tendency. Variables of interest were compared with Pearson’s χ 2 or Student’s test. Results In total, 929 febrile neutropenia episodes were analyzed. The mean age was 7.5 years, 55.3% were female. Hematologic malignancies were the most frequent type of malignances in 50.8%. Acute lymphoblastic leukemia (ALL) was the underlying disease in 41%. Of the 929 FN episodes, 180 (19.3%) were discharged with neutropenia. Patients with ALL were the most frequent in 49.4%, followed by acute myeloid leukemia 18.8% and rhabdomyosarcoma 6.6%. Thirty-five percent were in maintenance therapy, 22% in remission induction therapy, and 9% in consolidation. 19.4% of discharged patients received granulocyte-colony stimulating factor. Ten patients (5.5%) were re-admitted during the 7 days following discharge. Six patients returned for chemotherapy administration and one was scheduled for liver biopsy. Three patients were re-admitted due to infectious complications (1.6%), none of them were under oral antibiotic treatment; two patients due to FN without microbiological isolation and one patient with septic shock due to multi-drug-resistant Pseudomonas aeruginosa. Older patients had a higher risk of readmission, with a mean age of 14.6 years (SD 4.6 years, 95% CI 7.7–21.6) (P = 0.01), compared with the mean of 7.7 years (SD 2.7 years, (95% CI 7.0, – 8.4) of patients who were not re-admitted. Conclusions In our population of pediatric patients with FN who were discharged before neutrophil recovery, readmission due to infectious complications was low (1.6%). Discharging patients with persistent neutropenia who are afebrile and had completed a course of antibiotics seems an acceptable practice with a low risk of readmission.

New guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients

2007 ◽  
Vol 83 (7) ◽  
pp. 54-63 ◽  
Author(s):  
Ana Verena Almeida Mendes ◽  
Roberto Sapolnik ◽  
Núbia Mendonça
Keyword(s):  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Clinical Management ◽  
Oncology Patients ◽  
New Guidelines

Mannose-binding lectin (MBL) and the risk for febrile neutropenia and infection in pediatric oncology patients with chemotherapy

2010 ◽  
Vol 57 (1) ◽  
pp. 89-96 ◽  
Author(s):  
F.N.J. Frakking ◽  
J. Israëls ◽  
L.C.M. Kremer ◽  
T.W. Kuijpers ◽  
H.N. Caron ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Mannose Binding Lectin ◽  
Oncology Patients ◽  
Mannose Binding ◽  
Binding Lectin

Outpatient versus inpatient IV antibiotic management for pediatric oncology patients with low risk febrile neutropenia: A randomised trial

2014 ◽  
Vol 61 (8) ◽  
pp. 1427-1433 ◽  
Author(s):  
Lisa M. Orme ◽  
Franz E. Babl ◽  
Chris Barnes ◽  
Peter Barnett ◽  
Susan Donath ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Randomised Trial ◽  
Low Risk ◽  
Oncology Patients ◽  
Antibiotic Management

The morbidity and mortality of pediatric oncology patients presenting to the intensive care unit with septic shock

2008 ◽  
Vol 51 (5) ◽  
pp. 584-588 ◽  
Author(s):  
Catherine M. Pound ◽  
Donna L. Johnston ◽  
Rachel Armstrong ◽  
Isabelle Gaboury ◽  
Kusum Menon
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Pediatric Oncology ◽  
Morbidity And Mortality ◽  
Oncology Patients

scholarly journals STUDY OF SERUM LACTATE LEVELS IN PATIENTS WITH SEPSIS ON THE BASIS OF SURVIVAL AND NON-SURVIVAL

2021 ◽  
pp. 8-10
Author(s):  
Anisha Tanwar ◽  
Bushra Fiza ◽  
Bhupesh Medatwal ◽  
Rubal Singh ◽  
Maheep Sinha
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Lactic Acid ◽  
Survival Rate ◽  
Lactate Concentration ◽  
Serum Lactate ◽  
Mortality Prediction ◽  
P Value ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

INTRODUCTION:- Sepsis is a leading cause of morbidity and mortality internationally Early spotting and . interventions are essential to ensure better patient's outcome. Lactate concentration in septic patients is of particular prognostic value in predicting septic shock and mortality. AIM:- The present study was intended to evaluate the serum Lactate levels on the basis of severity rate in patients suffering of sepsis, severe sepsis and septic shock. MATERIAL & METHOD:- 100 patients diagnosed for sepsis were enrolled for the study and they were grouped as sepsis (n=30), severe sepsis (n=37)and septic shock (n=33). On the basis of survival rate serum Lactate levels in patients with sepsis were estimated in all the 3 categories of subjects according to the inclusion criteria. A p-Value of ≤0.05 were considered as statistically significant. RESULT:- In the present study when the lactate levels were evaluated among all the three categories, it was observed that the Lactate levels were found to be statistically significant (p-value <0.0001). Lactic acid evaluated on the basis of survival rate was also found to be statistically significant with the p-Value 0.015. CONCLUSION:- Lactic acid could be utilized as a reliable marker to assess prognosis at the initial phase of presentation because its initial evaluation shows good predictability in mortality prediction in sepsis patients.

scholarly journals LIMFOSIT T CD4+SEBAGAI PERAMAL PERJALANAN PENYAKIT PASIEN YANG MENGALAMI SEPSIS

2016 ◽  
Vol 19 (3) ◽  
pp. 178
Author(s):  
Lestari Ekowati ◽  
Aryati Aryati ◽  
Hardiono Hardiono
Keyword(s):  
Septic Shock ◽  
T Lymphocyte ◽  
Roc Curve ◽  
Lymphocyte Count ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Survival Group ◽  
Common Cause ◽  
Significant Difference ◽  
Very High

Sepsis is the most common cause of ICU mortality in USA. Mortality of sepsis in developing countries is still very high, about 50- 70% and has became a 80% incidence in septic shock. There was a decrease of CD4+ T lymphocyte count in patients with sepsis caused by apoptosis indicating septic patients suffered from immune functional impairment. CD4+ T lymphocyte count can reflect the severity of sepsis and predict the prognosis of the patients with sepsis effectively. Eighty eight (88) patients who met sepsis criteria were studied. The researchers collected clinical variables of all patients within 24 hours diagnosis of sepsis, and calculated APACHE II score. At the same time, blood sample were taken to measure the CD4+ T lymphocyte count. The data were analyzed using independent Student-T-test and ROC curve was used for prognosis. There is a significant difference in CD4+ T lymphocyte count between non survival and survival group (non survival group 203±178 cells/μL, survival group 442±303 cells/μL, p<0.001), and the percentage of CD4+ T lymphocyte (non survival group 25.05±11.55%, survival group 34.38±9.15%, p<0.001). There is an under ROC curve for CD4+ T lymphocyte count was 0.81, and for the percentage of CD4+ T lymphocyte was 0.748. Cut off value for CD4+ T lymphocyte count was 204 cells/μL, and the percentage of CD4+ T lymphocytes was 25.23%. Based on this study, the CD4+ T lymphocyte count can be used as a predictor of prognosis in sepsis patients.

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