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Life-threatening infections during treatment for acute lymphoblastic leukemia on the Malaysia-Singapore 2003 and 2010 clinical trials: A risk prediction model.
Oh, Bernice L Z; Fan, Lijia; Lee, Shawn H R; Foo, Koon Mian; Chiew, Kean Hui; Seeto, Zelia Z L; Chen, Zhi Wei; Neoh, Cheryl C C; Liew, Germaine S M; Eng, Jing Jia; Lam, Joyce C M; Quah, Thuan Chong; Tan, Ah Moy; Chan, Yiong Huak; Yeoh, Allen E J.
Afiliación
  • Oh BLZ; Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
  • Fan L; Department of Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore.
  • Lee SHR; Division of Critical Care, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.
  • Foo KM; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Chiew KH; Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
  • Seeto ZZL; Department of Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore.
  • Chen ZW; Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore.
  • Neoh CCC; Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
  • Liew GSM; Department of Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore.
  • Eng JJ; Department of Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore.
  • Lam JCM; Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
  • Quah TC; Department of Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore.
  • Tan AM; Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
  • Chan YH; Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore.
  • Yeoh AEJ; Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore.
Asia Pac J Clin Oncol ; 18(5): e456-e468, 2022 Oct.
Article en En | MEDLINE | ID: mdl-35134276
AIM: Life-threatening infections significantly impact the care of children undergoing therapy for acute lymphoblastic leukemia (ALL) who are at risk of severe sepsis due to both host and treatment factors. Our aim was to develop a life-threatening infection risk prediction model that would allow remote rapid triage of patients to reduce time to first dose of antibiotics and sepsis-related mortality. METHODS: A retrospective analysis of 2068 fever episodes during ALL therapy was used for model building and subsequent internal validation. RESULTS: Three hundred and seventy-seven patients were treated for ALL in two institutions with comparable critical and supportive care resources. A total of 55 patients accounted for 71 admissions to the critical care unit for sepsis that led to eight septic deaths during a 16-year study period. A retrospective analysis of risk factors for sepsis enabled us to build a model focused on 13 variables that discriminated admissions requiring critical care well: area under the receiver operating characteristic curve of .82; 95% CI .76-.87, p<.001, and Brier score of .033. Significant univariate predictors included neutropenia, presence of symptoms of abdominal pain, diarrhea, fever during induction or steroid-based phases, and the lack of any localizing source of infection at time of presentation. CONCLUSION: We have developed a risk prediction model that can reliably identify ALL patients undergoing treatment who are at a higher risk of life-threatening sepsis. Clinical applicability can potentially be extended to low-middle income settings, and its utility should be further studied in real-world settings.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sepsis / Leucemia-Linfoma Linfoblástico de Células Precursoras Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Child / Humans País/Región como asunto: Asia Idioma: En Revista: Asia Pac J Clin Oncol Asunto de la revista: NEOPLASIAS Año: 2022 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Australia
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sepsis / Leucemia-Linfoma Linfoblástico de Células Precursoras Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Child / Humans País/Región como asunto: Asia Idioma: En Revista: Asia Pac J Clin Oncol Asunto de la revista: NEOPLASIAS Año: 2022 Tipo del documento: Article País de afiliación: Singapur Pais de publicación: Australia