Risk Factors Of Sepsis After Chemotherapy In Children With Acute Lymphoblastic Leukemia

Objective:To investigate the clinical characteristics of infection in children with acute lymphocytic leukemia(ALL)after chemotherapy,and to analyze the risk factors of sepsis.Methods:Collected the dates of 63 cases with ALL,on age,risk stratification,chemotherapy,glucocorticoid,central vermiculum and laboratory test during the first diagnosis and treated with CCCG-2015-ALL protocol during our hospital in April 2018 to September 2020.The clinical characteristics and risk factors of infection and sepsis after chemotherapy were analyzed retrospectively.Results:The study collected a total of 1276 courses,including 483 times of low-risk(LR)groups and 793 times of inter/high-risk(I/HR)groups.The cases of infection after chemotherapy were 294,the incidence of infection(infections/courses)was 23.0%.In the LR group,there were 73 times(15.1%)of infection,while the I/HR group were 221 times(27.9%).In all courses,there occured 145times of sepsis,sepsis rate(sepsis/infections)was 49.3%.The sepsis rate in I/HR group(123times,75.7%)was higher than that in the LR group(22 times,30.1%),(P<0.001).Induction stage,consolidation stage,continued I stage and maintenance stage were 81.6%,10.9%,26.7%,11.6%,11.6%.The incidence of infections induced by induction stage was higher than other stages(P<0.001).Sepsis mainly occured in induction stage and continuing I stage,which sepsis rates were 53.3%and 69.9%,withing the consolidate stage and the maintenance stage of 30.8%and23.1%.The sepsis rate of continue I stage was highest(P<0.05).In the continue I stage,the sepsis rate in the I/HR group(88.9%),higher than that in the LR group(10.0%).Among all sepsis cases,the incidence of neutropenia in the continue I stage had the highest(93.1%),followed by the induction stage(87.5%).The sepsis rate of the duration of neutropenia>14 days group was 72.9%,higher than<7days group(29.4%)and 7～14 days group(42.7%),(P<0.001).The sepsis rate in the group with the interval from the beginning of chemotherapy to the occurrence of neutropenia(chemotherapy-neutropenia time)<7 days was 56.6%,which was higher than the chemotherapy-neutropenia time 7-14 days group(39.8%)and the>14 days group(32.0%),(P=0.003).The comparison of age,sex,glucocorticoid,PICC,hemoglobin,platelet count,albumin,alanine aminotransferase and fibrinogen showed that the sepsis rates were different with or without glucocorticoid(P=0.004).Logistic regression analysis showed that the neutrophils<0.1×10~9/L(OR:1.896,95%CI:1.012～2.024),the duration of neutropenia>14days(OR:3.461,95%CI:2.036～6.058),and the chemotherapy-neutropenia time<7 days(OR:2.364,95%CI:1.388～5.846)were independent risk factors for sepsis.Conclusion:Sepsis is a common severe complication in the treatment of children with ALL.The results showed that the neutrophil count<0.1×10~9/L,neutropenia time>14 days and chemotherapy-neutropenia time<7 days are independent risk factors for sepsis in children with ALL.Chemotherapy-neutropenia time<7 days can be used as an index for early prediction of sepsis...