Advancing the Identification of Risk Factors for Invasive Fungal Disease in Children with Cancer

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Mycology

Background:

• Invasive fungal disease (IFD) significantly contributes to morbidity and mortality in immunocompromised pediatric patients.
• Identifying specific risk factors for IFD in children with cancer and febrile neutropenia is crucial for timely intervention.

Purpose of the Study:

• To identify risk factors for invasive fungal disease (IFD) in immunocompromised pediatric cancer patients with persistent high-risk febrile neutropenia (HRFN).
• To develop and validate a predictive model for IFD risk stratification.

Main Methods:

• Multicenter prospective cohort study with nested retrospective analysis.
• Analysis of 174 episodes of persistent HRFN, identifying IFD cases and causative fungi (filamentous vs. yeasts).
• Logistic regression and survival analyses were used to determine significant risk factors.

Main Results:

• Invasive fungal disease (IFD) was confirmed in 19.5% of HRFN episodes.
• Significant risk factors for IFD included male sex (OR 4.04), adolescence (OR 4.65), C-reactive protein ≥ 90 mg/L (OR 3.13), and critical care unit transfer (OR 10.73).
• The predictive model showed strong discrimination (AUC 0.84) with high sensitivity (79.4%) and specificity (82.1%).

Conclusions:

• Adolescents, particularly males with severe clinical conditions and elevated inflammatory markers, are at the highest risk for IFD during HRFN.
• A risk factor-based model can aid in early risk stratification and guide targeted antifungal prophylaxis or therapy.
• External validation is needed to confirm results and optimize clinical applicability.