Exploring the association of hemoglobin level and adverse events in children with cancer presenting with fever in neutropenia

In children and adolescents with fever in neutropenia (FN) during chemotherapy for cancer, hemoglobin ≥90 g/L at presentation with FN had been associated with adverse events (AE). This analysis explored three hypothetical pathophysiological mechanisms potentially explaining this counterintuitive fin...

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Bibliographic Details
Published in:PloS one 2014-07, Vol.9 (7), p.e101696
Main Authors: Ammann, Roland A, Niggli, Felix K, Leibundgut, Kurt, Teuffel, Oliver, Bodmer, Nicole
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Analysis
Anemia
Antineoplastic Agents - adverse effects
Bacterial infections
Blood
Blood cells
Blood transfusion
Cancer
Cancer therapies
Chemotherapy
Child
Child, Preschool
Children
Data collection
Dehydration
Dehydration (Physiology)
Erythrocytes
Female
Fever
Fever - etiology
Health risks
Hematology
Hemoglobin
Hemoglobins
Hemoglobins - analysis
Humans
Hypotheses
Infant
Infections
Leukocytes
Leukopenia
Logistic Models
Male
Medicine and Health Sciences
Neoplasms - complications
Neoplasms - drug therapy
Neutropenia
Neutropenia - etiology
Oncology
Patients
Pediatrics
Platelets
Regression analysis
Retrospective Studies
Risk
Statistical analysis
Studies
Systematic review
Transfusion
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Summary:In children and adolescents with fever in neutropenia (FN) during chemotherapy for cancer, hemoglobin ≥90 g/L at presentation with FN had been associated with adverse events (AE). This analysis explored three hypothetical pathophysiological mechanisms potentially explaining this counterintuitive finding, and further analyzed the statistical association between hemoglobin and AE. Two of 8 centers, reporting on 311 of 421 FN episodes in 138 of 215 patients participated in this retrospective analysis based on prospectively collected data from three databases (SPOG 2003 FN, transfusion and hematology laboratories). Associations with AE were analyzed using mixed logistic regression. Hemoglobin was ≥90 g/L in 141 (45%) of 311 FN episodes, specifically in 59/103 (57%) episodes with AE, and in 82/208 (39%) without (OR, 2.3; 99%CI, 1.1-4.9; P = 0.004). In FN with AE, hemoglobin was bimodally distributed with a dip around 85 g/L. There were no significant interactions for center, age and sex. In multivariate mixed logistic regression, AE was significantly and independently associated with leukopenia (leukocytes
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0101696