Risk factors for mortality in pediatric cancer patients with febrile neutropenia

Introduction: Febrile neutropenia is the most common complication in pediatric patients with malignancy. Mortality of children with febrile neutropenia remains high, particularly in Indonesia. A high morbidity rate and high treatment costs accompany this. Identified mortality risk variables are essential for the early management of neutropenia fever hospitalization. This study aims to analyze mortality risk factors in children with cancer who have neutropenic fever. Methods: This study was a retrospective cohort study of medical records from cancer children who had febrile neutropenia from January 2017 to December 2021. Patients who met the inclusion criteria were included in this study. Patients with incomplete data were excluded. Risk factors such as sex, nutritional status, pneumonia, thrombocytopenia, profound neutropenia, impaired liver function, impaired renal function, bacteremia, and elevated CRP levels were identified using bivariate and multivariate analysis. Result: There were 188 pediatric cancer patients with neutropenia fever who met the inclusion criteria. Forty-three children (22.9%) died. Multivariate analysis found that significant mortality risks were pneumonia (p <0.001; OR 15.923; 95% CI 3.762-67.389), thrombocytopenia (p <0.001; OR 4.939; 95% CI 1.993-12.242), profound neutropenia (p <0,001 OR 5.075; 95% CI 2.066-12.466) and bacteremia (p <0.004; OR 3.656; 95% CI 1.517-8.672). Other variables were not significant risk factors for mortality in children with febrile neutropenia cancer. Conclusion: Pneumonia, thrombocytopenia, profound neutropenia, and bacteremia are risk factors for mortality in childhood cancer with neutropenia fever.