Supportive Care in Cancer

, Volume 25, Issue 11, pp 3523–3528 | Cite as

Can complications in febrile neutropenia be predicted? Report from a developing country

  • Sapna Oberoi
  • Anirban Das
  • Amita TrehanEmail author
  • Pallab Ray
  • Deepak Bansal
Original Article



Febrile neutropenia (FN) is an important cause of morbidity and mortality in children with acute lymphoblastic leukemia (ALL). We aimed to look at complications in febrile neutropenia and to derive a risk model for developing complications from the variables predicting complications.


Children on treatment for ALL, presenting with FN, were prospectively enrolled over a period of 1 year. Their clinical presentation, course during hospital stay, and outcomes were recorded. Complications recorded included septic shock, pneumonia requiring invasive or non-invasive ventilation, renal failure, neutropenic enterocolitis, encephalopathy, congestive heart failure, and bleeding manifestations.


There were 320 episodes of FN among 176 patients. Complications occurred during 73 (22.8%) episodes. Time since last chemotherapy ≤7 days [OR 2.2 (1–4.5)], clinical focus of infection [OR 2.7 (1.3–5.5)], undernutrition [OR 2.5 (1.1–5.5)], absolute neutrophil count (ANC) ≤ 100/μL [OR 2.8 (1.3–5.9)], and C-reactive protein (CRP) > 60 mg/L at admission [OR 13.3 (5.2–33.8)] were independent predictors of complications. A risk model (total score = 13) was developed based on these predictors. Children with score of ≥7 had 17.2 (7.7–38.6) odds of developing complications as compared to those with score <7. Score of <7 predicted children at lower risk of complications [sensitivity 88% (78.2–93.8%), specificity 72.5% (65.7–78.4%), PPV 53.6% (44.3–62.6%), NPV 94.4% (89.3–97.1%)].


Complications during febrile neutropenia are high in a developing country setup. A risk score model based on identified risk factors can possibly help in recognizing low-risk febrile neutropenic children at admission.


Children Febrile neutropenia India Morbidity Prediction 


Compliance with ethical standards

An informed consent was obtained from the parents. The study was approved by the research ethics board of the hospital.



Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Division of Pediatric Hematology Oncology, Department of Pediatrics, Advanced Pediatric CentrePostgraduate Institute of Medical Education & ResearchChandigarhIndia
  2. 2.Department of MicrobiologyPostgraduate Institute of Medical Education & ResearchChandigarhIndia

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