UPMC Children’s Hematology/Oncology Team Publishes Findings on Febrile Neutropenia and Risk for Readmission

New research from the Division of Pediatric Hematology/Oncology at UPMC Children’s published in the Journal of Pediatric Hematology Oncology has identified key risk factors associated with the readmission of pediatric oncology patients experiencing febrile neutropenia.

The study from the Division of Pediatric Hematology/Oncology at UPMC Children’s was led by Meghan McCormick, MD, MS. Ram Kalpatthi, MD, clinical research director of Pediatric Sickle Cell Research and director of Medical Student and Resident Education at UPMC Children's was the study’s senior author. Also contributing was division clinical director Louis Rapkin, MD, and Troy Richardson, PhD, from the Children’s Hospital Association.

Study Overview and Clinical Findings

Febrile neutropenia is a serious condition that arises when a patient has both a fever, usually due to an infection, and neutropenia, a lower-than-normal level of neutrophils. It is particularly worrisome in pediatric oncology patients because of their often-compromised immune system which can increase their vulnerability to potentially life-threatening infections.

Certain pediatric cancer patients are at higher risk for developing febrile neutropenia. In particular, children with hematologic malignancies like acute lymphoblastic leukemia (ALL), are more likely to experience the condition due to the intensity of their chemotherapy regimens which can produce prolonged periods of neutropenia. Patients receiving high-dose chemotherapy or undergoing stem cell transplants have also been shown to have an elevated risk.

Febrile neutropenia remains a significant cause of morbidity and mortality in pediatric cancer patients and continues to be a prevalent cause of unplanned admissions in children with cancer highlighting the need for ongoing research into better preventive strategies and treatments.

In their new study, Dr. McCormick and colleagues set out to identify the factors that may predispose patients experiencing febrile neutropenia to hospital readmission. The team analyzed pediatric cancer data from a five-year period between 2007 and 2012 in the PHIS+ database in a cohort of 2,349 individuals with an initial hospitalization.

The study found that among the 2,349 individuals, 7.3% - 294 cases – experienced a readmission within 7 days following the index admission.Within this patient population, the team’s research revealed four main patient or disease-state attributes that were associated with increased risk of readmission. These included:

• Patients in the lowest quartile for median household income
• Individuals with acute lymphoblastic leukemia
• Absence or lack of anaerobic-acting antimicrobials during the patient’s first hospitalization
• An absolute neutrophil count of less than 200 cells/μL when they were released from the hospital after their initial admission

It should be noted that in more than 75% of the total readmissions, patients had an absolute neutrophil count of less than 100.

The team’s research also revealed that hospitalization rates for febrile neutropenia appear to increase over time.

The study also points toward readmitted patients requiring longer hospital stays, with a median of 5 days, as well as higher overall costs of care compared to the costs of their index hospitalization.

These findings point to a need for greater focus on socio-economic factors and the precise management of neutropenic fevers in this vulnerable patient population. While absolute neutrophil count is incorporated into many strategies for managing fever, more work is needed to address these broader systemic issues to reduce readmission rates and improve patient outcomes.

Read more using the reference link below.

Reference

McCormick M, Richardson T, Rapkin L, Kalpatthi R. Risk Factors for Readmission Following Febrile Neutropenia in Pediatric Oncology Patients. J Pediatr Hematol Oncol. 2023 May 1; 45(4): e496-e501.