Clinical Profile and Factors Associated with Mortality in Febrile Neutropenia among Children with Acute Lymphoblastic Leukemia: A Single-Center Study in Indonesia
Keywords:
febrile neutropenia, Acute lymphoblastic leukemia, clinical profile, Pediatric, mortality, IndonesiaAbstract
Background and aim: Febrile neutropenia (FN) is a life-threatening oncologic emergency in children with acute lymphoblastic leukemia (ALL), associated with substantial morbidity and mortality. This study aimed to describe the clinical profile of FN and identify factors associated with mortality in a resource-limited pediatric oncology setting.
Methods: An observational analytic study with a cross-sectional design was conducted using secondary data from electronic medical records of pediatric ALL patients with FN at Dr. Soetomo General Academic Hospital between January 2023 and July 2025. The unit of analysis was FN episodes. Demographic, clinical, microbiological, and outcome data were collected. Mortality-associated factors were analyzed using chi-square, Mann–Whitney U, and independent t-tests.
Results: A total of 135 patients with 206 FN episodes were analyzed (mean 1.52 episodes/patient). Most episodes occurred in children aged <5 years (51.9%) and males (58.3%). Febrile Neutropenia most commonly developed during induction chemotherapy (42.2%), with high-risk ALL protocol predominating (52.9%). Profound neutropenia was present in 36.9% of episodes. Culture positivity was found in 28.6% of episodes, with gram-negative bacteria predominating (54.9%), particularly Pseudomonas aeruginosa (15.69%). Overall episode mortality rate was 16.5% (34/206 episodes; 25.2% per patient). Factors significantly associated with mortality included high-risk protocol, profound neutropenia, positive cultures, prolonged hospitalization, prolonged fever, delayed ANC recovery, lower hemoglobin, lower platelet count, and lower ANC (p<0.05).
Conclusions: High-risk protocol, severe neutropenia, bacteremia, and unfavorable hematological parameters were associated with mortality, highlighting the need for tailored risk stratification and antimicrobial stewardship in pediatric oncology settings.
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