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Exploring the Association of Hemoglobin Level and Adverse Events in Children with Cancer Presenting with Fever in Neutropenia

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  • Roland A Ammann
  • Felix K Niggli
  • Kurt Leibundgut
  • Oliver Teuffel
  • Nicole Bodmer

Abstract

Background: 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. Methods: 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. Results: 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

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  • Roland A Ammann & Felix K Niggli & Kurt Leibundgut & Oliver Teuffel & Nicole Bodmer, 2014. "Exploring the Association of Hemoglobin Level and Adverse Events in Children with Cancer Presenting with Fever in Neutropenia," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-8, July.
    • Handle: RePEc:plo:pone00:0101696
    DOI: 10.1371/journal.pone.0101696
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    1. Robert S Phillips & Thomas Lehrnbecher & Sarah Alexander & Lillian Sung, 2012. "Updated Systematic Review and Meta-Analysis of the Performance of Risk Prediction Rules in Children and Young People with Febrile Neutropenia," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-9, May.
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