Mortality Score of Paganini et al for a Child with a Malignancy and Febrile Neutropenia

 

Patient selection:

(1) age < 18 years

(2) malignant disease (leukemia, lymphoma, solid organ)

(3) neutropenia following chemotherapy with either an absolute neutrophil count < 500 per µL or an absolute count <= 1,000 per µL with expected nadir to < 500 per µL

(4) >= 1 episode of fever > 38.5°C or >= 2 episodes > 38°C

(5) excluded bone marrow transplantation

 

Parameters:

(1) advanced stage of underlying malignant disease

(2) associated comorbidity

(3) bacteremia

 

Parameter	Finding	Points
stage of underlying malignancy	not-advanced	0
	advanced	3
associated comorbidity	none	0
	present	2
bacteremia	absent	0
	present	1

 

where:

• Advanced stage includes (a) bone marrow involvement, (b) recurrence, (c) development of a second malignancy, (d) therapy with high-dose myelotoxic chemotherapy, or (e) genetic disease.

• Comorbidity included: refractory bleeding, refractory hypoglycemia and hypocalcemia, hypotension, altered mental status, renal insufficiency, hepatic dysfunction, respiratory failure.

 

total score =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 6

• The higher the score the greater the risk of mortality.

• Low risk patients are discharged 24 hours after hospitalization and followed daily as outpatients. High risk patients remain hospitalized until stable, afebrile and with an absolute neutrophil count > 100 per µL.

Total Score	Percent Mortality in Derivation Set
0 to 3	0%
4	6%
5	15%
6	40%

 

Performance:

• Using a cutoff > 3, the score had a sensitivity of 84% and specificity of 83% for predicting mortality. The negative predictive value was 99.5%.