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Watson V, Smith CT, Bonnett LJ. Systematic review of methods used in prediction models with recurrent event data. Diagn Progn Res 2024; 8:13. [PMID: 39103900 DOI: 10.1186/s41512-024-00173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/13/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Patients who suffer from chronic conditions or diseases are susceptible to experiencing repeated events of the same type (e.g. seizures), termed 'recurrent events'. Prediction models can be used to predict the risk of recurrence so that intervention or management can be tailored accordingly, but statistical methodology can vary. The objective of this systematic review was to identify and describe statistical approaches that have been applied for the development and validation of multivariable prediction models with recurrent event data. A secondary objective was to informally assess the characteristics and quality of analysis approaches used in the development and validation of prediction models of recurrent event data. METHODS Searches were run in MEDLINE using a search strategy in 2019 which included index terms and phrases related to recurrent events and prediction models. For studies to be included in the review they must have developed or validated a multivariable clinical prediction model for recurrent event outcome data, specifically modelling the recurrent events and the timing between them. The statistical analysis methods used to analyse the recurrent event data in the clinical prediction model were extracted to answer the primary aim of the systematic review. In addition, items such as the event rate as well as any discrimination and calibration statistics that were used to assess the model performance were extracted for the secondary aim of the review. RESULTS A total of 855 publications were identified using the developed search strategy and 301 of these are included in our systematic review. The Andersen-Gill method was identified as the most commonly applied method in the analysis of recurrent events, which was used in 152 (50.5%) studies. This was closely followed by frailty models which were used in 116 (38.5%) included studies. Of the 301 included studies, only 75 (24.9%) internally validated their model(s) and three (1.0%) validated their model(s) in an external dataset. CONCLUSIONS This review identified a variety of methods which are used in practice when developing or validating prediction models for recurrent events. The variability of the approaches identified is cause for concern as it indicates possible immaturity in the field and highlights the need for more methodological research to bring greater consistency in approach of recurrent event analysis. Further work is required to ensure publications report all required information and use robust statistical methods for model development and validation. PROSPERO REGISTRATION CRD42019116031.
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Affiliation(s)
- Victoria Watson
- Department of Health Data Sciences, University of Liverpool, Liverpool, UK.
| | - Catrin Tudur Smith
- Department of Health Data Sciences, University of Liverpool, Liverpool, UK
| | - Laura J Bonnett
- Department of Health Data Sciences, University of Liverpool, Liverpool, UK
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2
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Kaya Z, Alıcı N, Kırkız S, Koçak Ü. Identifying Risk Factors and Improving Preventive Strategies for Febrile Neutropenia in Children with Leukemia Receiving Ciprofloxacin Prophylaxis. Turk J Haematol 2023; 40:183-186. [PMID: 37314294 PMCID: PMC10476261 DOI: 10.4274/tjh.galenos.2023.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/03/2023] [Indexed: 09/01/2023] Open
Abstract
The purpose of this study was to identify risk factors and improve preventive strategies for febrile neutropenia (FEN) in children with leukemia who were receiving ciprofloxacin prophylaxis. The study included 100 children with leukemia [n=80 with acute lymphoblastic leukemia and n=20 with acute myeloblastic leukemia (AML)]. Patients were divided into two groups based on whether they had three or fewer FEN episodes (Group 1) or more than three FEN episodes (Group 2). Group 1 contained 63 (63%) of the 100 patients, while Group 2 contained 37 (37%). Older age (≥7 years), leukemia type, prolonged neutropenia (>10 days), and the presence of neutropenia and hypogammaglobulinemia at diagnosis were all risk factors for having more than three FEN episodes. Our findings suggest that, in addition to ciprofloxacin prophylaxis, identifying risk factors and improving preventive strategies could help reduce FEN episodes in children with leukemia.
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Affiliation(s)
- Zühre Kaya
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
| | - Nurettin Alıcı
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
| | - Serap Kırkız
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
| | - Ülker Koçak
- Gazi University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Türkiye
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3
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Willmer D, Zöllner SK, Schaumburg F, Jürgens H, Lehrnbecher T, Groll AH. Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma. Cancers (Basel) 2021; 13:cancers13091990. [PMID: 33919049 PMCID: PMC8122626 DOI: 10.3390/cancers13091990] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 01/13/2023] Open
Abstract
Simple Summary Infections are an important cause of morbidity and mortality in childhood cancer treatment. The aim of our retrospective study was to assess the infectious burden in pediatric sarcoma patients during neoadjuvant chemotherapy administered according to the EWING 2008, CWS SoTiSaR and EURAMOS clinical trial or registry. Our analyses indicate a substantial infectious morbidity in this group of patients, with 58.8% experiencing at least one episode of febrile neutropenia (FN) and 20.6% at least one microbiologically documented infection (MDI). We also identified parameters that impact on the occurrence of FN and MDIs, including treatment protocol, patient age, and mucositis. These findings may contribute to a better risk stratification for prevention and management of FN and infections as well as for maintaining quality of life, cost control, and optimum outcomes of anticancer treatment. Abstract The purpose of this retrospective, single-center cohort study was to assess the infectious burden in pediatric sarcoma patients during neoadjuvant chemotherapy. The review included all patients with a new diagnosis of Ewing sarcoma, osteosarcoma or soft tissue sarcoma between September 2009 and December 2018 who were enrolled in the EWING 2008, CWS SoTiSaR and EURAMOS clinical trial or registry. Primary endpoints were the occurrence of febrile neutropenia (FN) and microbiologically documented infection (MDI). Parameters with a potential impact on FN and MDI were also analyzed. A total of 170 sarcoma patients (median age: 13 years, range: 0–21; 96 m/74 f) received 948 chemotherapy courses (median: 6; range: 2–8). Of these patients, 58.8% had ≥1 FN episode and 20.6% ≥ 1 MDI. FN occurred in 272/948 courses (28.7%) with fever of unknown origin (FUO) in 231 courses and 45 MDI and 19 clinically documented infections (CDI) occurring in a total of 57 courses. Patients enrolled in EWING 2008 had significantly more FN (p < 0.001), infections (p = 0.02) and MDI (p = 0.035). No infection-related deaths were observed. Younger age, tumor type and localization, and higher median and maximum mucositis grades were significantly associated with higher numbers of FN (p < 0.001), and younger age (p = 0.024) and higher median mucositis grade (p = 0.017) with MDI. The study shows substantial infectious morbidity in sarcoma patients during neoadjuvant chemotherapy treatment and opportunities to improve prevention and management.
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Affiliation(s)
- Denise Willmer
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children’s Hospital Münster, 48149 Münster, Germany; (D.W.); (S.K.Z.); (H.J.)
| | - Stefan K. Zöllner
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children’s Hospital Münster, 48149 Münster, Germany; (D.W.); (S.K.Z.); (H.J.)
- Department of Pediatric Oncology & Hematology, Pediatrics III, University Hospital of Essen, 45147 Essen, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany;
| | - Heribert Jürgens
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children’s Hospital Münster, 48149 Münster, Germany; (D.W.); (S.K.Z.); (H.J.)
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, 60590 Frankfurt am Main, Germany;
| | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children’s Hospital Münster, 48149 Münster, Germany; (D.W.); (S.K.Z.); (H.J.)
- Correspondence: ; Tel.: +49-251-834-7742; Fax: +49-251-834-7828
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Kara SS, Tezer H, Polat M, Cura Yayla BC, Bedir Demirdağ T, Okur A, Fettah A, Kanık Yüksek S, Tapısız A, Kaya Z, Özbek N, Yenicesu İ, Yaralı N, Koçak Ü. Risk factors for bacteremia in children with febrile neutropenia. Turk J Med Sci 2019; 49:1198-1205. [PMID: 31385488 PMCID: PMC7018307 DOI: 10.3906/sag-1901-90] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background/aim Bacteremia remains an important cause of morbidity and mortality during febrile neutropenia (FN) episodes. We aimed to define the risk factors for bacteremia in febrile neutropenic children with hemato-oncological malignancies. Materials and methods The records of 150 patients aged ≤18 years who developed FN in hematology and oncology clinics were retrospectively evaluated. Patients with bacteremia were compared to patients with negative blood cultures. Results The mean age of the patients was 7.5 ± 4.8 years. Leukemia was more prevalent than solid tumors (61.3% vs. 38.7%). Bacteremia was present in 23.3% of the patients. Coagulase-negative staphylococci were the most frequently isolated microorganism. Leukopenia, severe neutropenia, positive peripheral blood and central line cultures during the previous 3 months, presence of a central line, previous FN episode(s), hypotension, tachycardia, and tachypnea were found to be risk factors for bacteremia. Positive central line cultures during the previous 3 months and presence of previous FN episode(s) were shown to increase bacteremia risk by 2.4-fold and 2.5-fold, respectively. Conclusion Presence of a bacterial growth in central line cultures during the previous 3 months and presence of any previous FN episode(s) were shown to increase bacteremia risk by 2.4-fold and 2.5-fold, respectively. These factors can predict bacteremia in children with FN.
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Affiliation(s)
- Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Meltem Polat
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Burcu Ceylan Cura Yayla
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Tuğba Bedir Demirdağ
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Arzu Okur
- Department of Pediatric Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ali Fettah
- Department of Pediatric Hematology-Oncology, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey
| | - Saliha Kanık Yüksek
- Department of Pediatric Infectious Diseases, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey
| | - Anıl Tapısız
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zühre Kaya
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Namık Özbek
- Department of Pediatric Hematology-Oncology, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey
| | - İdil Yenicesu
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Neşe Yaralı
- Department of Pediatric Hematology-Oncology, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey
| | - Ülker Koçak
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Calitri C, Ruberto E, Castagnola E. Antibiotic prophylaxis in neutropenic children with acute leukemia: Do the presently available data really support this practice? Eur J Haematol 2018; 101:721-727. [PMID: 30107054 DOI: 10.1111/ejh.13162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/30/2022]
Abstract
Antibiotics are frequently administered for prophylaxis of fever in neutropenic children with cancer. This strategy is mainly derived from adults' data, and various pediatric studies evidenced the effectiveness of antibiotics (eg, fluoroquinolones) in the prevention of febrile neutropenia. However, only two pediatric randomized, double-blind, placebo-controlled trials have been performed, with a total of 262 leukemic children enrolled, and no other one was ever powered for analyzing effectiveness over other infectious complications. In an era of increasing antibiotic resistance, the widespread use of antibiotic prophylaxis in neutropenic leukemic children needs to be strongly supported.
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Affiliation(s)
| | - Eliana Ruberto
- Department of Translational Medical Science, Section of Pediatrics, Università di Napoli Federico II, Napoli, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
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6
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Calitri C, Caviglia I, Cangemi G, Furfaro E, Bandettini R, Fioredda F, Amoroso L, Faraci M, Risso FM, Mattioli G, Moscatelli A, Haupt R, Castagnola E. Performance of 1,3-β-D-glucan for diagnosing invasive fungal diseases in children. Mycoses 2017; 60:789-795. [PMID: 28833726 DOI: 10.1111/myc.12664] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/20/2017] [Accepted: 07/13/2017] [Indexed: 01/05/2023]
Abstract
Plasma 1,3-β-D-glucan (BDG) is indicated as a tool for early diagnosis of invasive fungal diseases (IFD). However, data on its diagnostic value are scarce in children. Therefore, definition of BDG test performance in paediatrics is needed. BDG was evaluated in children admitted to "Istituto Giannina Gaslini," Genoa, Italy, who developed clinical conditions at risk for IFD. Results were analysed for sensitivity, specificity, predictive values, likelihood ratios, accuracy, informedness and probability of missing one case by a negative test. A total of 1577 BDG determinations were performed on 255 patients (49% males, median age 5.4 years). Overall 46 IFD were diagnosed, 72% proven/probable. The test performance was evaluated for 80 pg/mL, 120 pg/mL, 200 pg/mL, 350 pg/mL, 400 pg/mL cut offs. Sensitivity was always <0.80 and specificity > 0.90 only for cut offs ≥200 pg/mL. Negative predictive value was ≥0.90 for all the cut offs evaluated, while positive predictive value resulted barely 0.50 (8% IFD prevalence). Accuracy was never >0.90, and informedness was at best 0.50. The risk of missing one IFD by a negative result was < 10%. Analyses in haemato-oncological or newborn patients did not show major differences. Detection of serum BDG does not appear a valuable adjunctive diagnostic tool for IFD in paediatrics.
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Affiliation(s)
- Carmelina Calitri
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Ilaria Caviglia
- Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Giuliana Cangemi
- Laboratory of Microbiology, Istituto Giannina Gaslini, Genoa, Italy
| | - Elisa Furfaro
- Department Health Science, University of Genoa, Genoa, Italy
| | | | | | | | - Maura Faraci
- Hemopoietic Stem Cell Transplant Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Francesco M Risso
- Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Riccardo Haupt
- Epidemiology, Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy
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Castagnola E, Mikulska M, Viscoli C. Prophylaxis and Empirical Therapy of Infection in Cancer Patients. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7173426 DOI: 10.1016/b978-1-4557-4801-3.00310-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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8
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Castagnola E. The role of prophylaxis of bacterial infections in children with acute leukemia/non-hodgkin lymphoma. Pediatr Rep 2014; 6:5332. [PMID: 24987511 PMCID: PMC4076651 DOI: 10.4081/pr.2014.5332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/28/2014] [Indexed: 11/23/2022] Open
Abstract
Infections represent a well-known complication of antineoplastic chemotherapy that may cause delay of treatment, with alteration of the antineoplastic program and dose-intensity, or even the death of a patient that could heal from his/her neoplasia. Bacterial infections are a major cause of morbidity and mortality in patients who are neutropenic following chemotherapy for malignancy. Therefore a program of antibiotic prophylaxis for febrile neutropenia may be considered in the management strategy of cancer patients.
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Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy
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Cecinati V, Principi N, Brescia L, Esposito S. Antibiotic prophylaxis in children with cancer or who have undergone hematopoietic cell transplantation. Eur J Clin Microbiol Infect Dis 2013; 33:1-6. [PMID: 23884866 DOI: 10.1007/s10096-013-1932-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/10/2013] [Indexed: 11/25/2022]
Abstract
Bacterial infections are common in children with cancer and can lead to life-threatening complications. Infections in these patients mainly occur during neutropenic periods, and may be caused by Gram-positive or Gram-negative bacteria. The patients at highest risk of serious infections include those with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML), and those undergoing myeloablative hematopoietic cell transplantation (HCT). This is a review with the main aim of making a critical appraisal of the literature, and summarising what is currently known and can be recommended. The most significant studies support the use of floroquinolones (mainly ciprofloxacin) as the most rational approach to treat pediatric patients with probably long-lasting neutropenia, although trimetoprim-sulphametoxazole and amoxicillin/clavulanate may theoretically be valid alternatives. No prophylaxis seems to be needed for children with cancer without severe neutropenia. However, a global evaluation of the studies of antibiotic prophylaxis in children with cancer indicates that there are not enough data to prepare definite guidelines for its use or avoidance in pediatric oncology, and so further studies are needed. It is not only important to define the best antibiotic regimens for the children in whom such prophylaxis is useful, but also to identify precisely those who do not need it. This would avoid the antibiotic misuse that probably occurs at the moment because many low-risk children with cancer are treated. As prophylaxis against infections requires long-term adherence to an antibiotic regimen, the attitudes and beliefs of stakeholders need to be fully considered.
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Affiliation(s)
- V Cecinati
- Division of Pediatric Hematology and Oncology, Department of Hematology, Santo Spirito Hospital, Pescara, Italy
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