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Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study
Background: Febrile neutropenia (FN) is the commonest fatal acute complication of cancer treatment in children. The need for regional clinical decision rules allowing for home-based care in those at low risk for adverse outcomes has been identified. Aims: To evaluate the prevalence and potential ris...
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| Format: | Thesis |
| Language: | English |
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Department of Paediatrics and Child Health
2022
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| _version_ | 1867613727380996096 |
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| access_status_str | Open Access |
| author | Adekunle, Motunrayo |
| author2 | Hendricks, Marc |
| author_browse | Adekunle, Motunrayo Hendricks, Marc |
| author_facet | Hendricks, Marc Adekunle, Motunrayo |
| author_sort | Adekunle, Motunrayo |
| collection | Thesis |
| description | Background: Febrile neutropenia (FN) is the commonest fatal acute complication of cancer treatment in children. The need for regional clinical decision rules allowing for home-based care in those at low risk for adverse outcomes has been identified. Aims: To evaluate the prevalence and potential risk factors for FN, identify adverse outcomes and validate a tool to identify risk for adverse outcomes in a cohort of children treated for cancer at the Red Cross War Memorial Children's Hospital, Cape-Town, South Africa. Methodology: A retrospective cohort study from 1st January 2017 to 31st December 2019. Results: In all, 179 patients had chemotherapy and 267 FN episodes occurred. Independent predictors of FN were AML (p = 0.039), ALL (p = 0.020) and intensive chemotherapy (p = < 0.001). Mucositis (p = 0.001), CVAD (p = 0.004, haematologic malignancies (p = 0.040), blood transfusion during FN episode (p = 0.001) and severe neutropenia (white cell counts< 0.3 x 109 cells/L) (p = < 0.001) were risk factors for adverse outcomes. The mortality rate from FN was 3.57%. Independent predictors of adverse outcomes were AML (p = 0.001), CVAD in-situ (p = 0.019) and severe neutropenia (p = 0.005). Validation of risk stratification for adverse outcomes using the Swiss Paediatric Oncology Group (SPOG) index with a cut-off value of nine demonstrated a sensitivity and specificity of 52.3% and 62.0%, respectively. Positive and negative predictive values were 56.3% and 58.2%, respectively, with an overall accuracy of 57.4%. In our cohort, coordinates of the curve are best able to predict adverse outcomes with a cut-off value of 7.5. Conclusion: Adverse outcomes from treatment are likely in children with AML, severe neutropenia and those with CVADs in-situ. A lower cut-off of 7.5 using the SPOG FN risk index best predicted adverse outcomes in our cohort. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/36504 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:40:44.771Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/36504 Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study Adekunle, Motunrayo Hendricks, Marc Davidson, Alan Haematology-Oncology Background: Febrile neutropenia (FN) is the commonest fatal acute complication of cancer treatment in children. The need for regional clinical decision rules allowing for home-based care in those at low risk for adverse outcomes has been identified. Aims: To evaluate the prevalence and potential risk factors for FN, identify adverse outcomes and validate a tool to identify risk for adverse outcomes in a cohort of children treated for cancer at the Red Cross War Memorial Children's Hospital, Cape-Town, South Africa. Methodology: A retrospective cohort study from 1st January 2017 to 31st December 2019. Results: In all, 179 patients had chemotherapy and 267 FN episodes occurred. Independent predictors of FN were AML (p = 0.039), ALL (p = 0.020) and intensive chemotherapy (p = < 0.001). Mucositis (p = 0.001), CVAD (p = 0.004, haematologic malignancies (p = 0.040), blood transfusion during FN episode (p = 0.001) and severe neutropenia (white cell counts< 0.3 x 109 cells/L) (p = < 0.001) were risk factors for adverse outcomes. The mortality rate from FN was 3.57%. Independent predictors of adverse outcomes were AML (p = 0.001), CVAD in-situ (p = 0.019) and severe neutropenia (p = 0.005). Validation of risk stratification for adverse outcomes using the Swiss Paediatric Oncology Group (SPOG) index with a cut-off value of nine demonstrated a sensitivity and specificity of 52.3% and 62.0%, respectively. Positive and negative predictive values were 56.3% and 58.2%, respectively, with an overall accuracy of 57.4%. In our cohort, coordinates of the curve are best able to predict adverse outcomes with a cut-off value of 7.5. Conclusion: Adverse outcomes from treatment are likely in children with AML, severe neutropenia and those with CVADs in-situ. A lower cut-off of 7.5 using the SPOG FN risk index best predicted adverse outcomes in our cohort. 2022-06-22T13:48:36Z 2022-06-22T13:48:36Z 2022 2022-06-08T08:44:54Z Master Thesis Masters MPhil http://hdl.handle.net/11427/36504 eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences |
| spellingShingle | Haematology-Oncology Adekunle, Motunrayo Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study |
| thesis_degree_str | Master's |
| title | Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study |
| title_full | Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study |
| title_fullStr | Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study |
| title_full_unstemmed | Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study |
| title_short | Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study |
| title_sort | prevalence risk factors and predictors of adverse outcomes of febrile neutropenia in oncology patients on chemotherapy at the red cross war memorial children s hospital a three year retrospective study |
| topic | Haematology-Oncology |
| url | http://hdl.handle.net/11427/36504 |
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