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ORIGINAL RESEARCH article

Front. Med.
Sec. Infectious Diseases: Pathogenesis and Therapy
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1488514

Predictors of Breakthrough Invasive Fungal Infections (BIFI) in Pediatric Acute Leukemia: A Retrospective Analysis and Predictive Model Development

Provisionally accepted
Yan Li Yan Li Li jun Qu Li jun Qu *Jian Wang Jian Wang *Ping tian Chen Ping tian Chen *Ao shuang Jiang Ao shuang Jiang *Hong jun Liu Hong jun Liu *
  • Department of Hematology and Oncology, Anhui Provincial Children's Hospital, Hefei, China

The final, formatted version of the article will be published soon.

    Objective: This study aims to identify key risk factors associated with the development of breakthrough invasive fungal infections (BIFI) in pediatric acute leukemia patients to improve early detection and intervention strategies. Method: A retrospective analysis was conducted on 160 pediatric patients with acute leukemia admitted to Anhui Provincial Children's Hospital between October 2018 and June 2022. The study evaluated the impact of various clinical parameters on BIFI risk using univariate and multivariable analyses, with data including patient demographics, treatment regimens, and infection outcomes. The predictive model was assessed using receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA).Result: Among the 160 pediatric acute leukemia patients, 34 (22.22%) developed BIFI. Univariate analysis identified longer durations of neutrophil deficiency (P < 0.001), broad-spectrum antibiotic use (P < 0.001), higher volumes of red blood cell transfusions (P = 0.001), and elevated C-reactive protein (CRP) levels (P < 0.001) as significant factors associated with BIFI. Multivariable analysis confirmed these as significant predictors, with odds ratios for neutrophil deficiency (OR = 1.38, 95% CI [1.15, 1.69]), antibiotic use (OR = 1.41, 95% CI [1.10, 1.84]), transfusions (OR = 2.54, 95% CI [1.39, 5.13]), and CRP levels (OR = 1.10, 95% CI [1.04, 1.17]). The model validation showed strong predictive performance with an AUC of 0.890 (95% CI: 0.828 -0.952), good calibration (Brier score = 0.099), and demonstrated clinical utility across a range of risk thresholds. Conclusion: The study highlights the importance of considering these key predictors in the management of pediatric acute leukemia patients to mitigate the risk of BIFI. Incorporating these factors into personalized treatment strategies could enhance early intervention, reduce infection rates, and improve overall patient outcomes.

    Keywords: Pediatric acute leukemia, Breakthrough invasive fungal infections, Predictive factors, Neutropenia, Risk model development

    Received: 30 Aug 2024; Accepted: 25 Nov 2024.

    Copyright: © 2024 Li, Qu, Wang, Chen, Jiang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Li jun Qu, Department of Hematology and Oncology, Anhui Provincial Children's Hospital, Hefei, China
    Jian Wang, Department of Hematology and Oncology, Anhui Provincial Children's Hospital, Hefei, China
    Ping tian Chen, Department of Hematology and Oncology, Anhui Provincial Children's Hospital, Hefei, China
    Ao shuang Jiang, Department of Hematology and Oncology, Anhui Provincial Children's Hospital, Hefei, China
    Hong jun Liu, Department of Hematology and Oncology, Anhui Provincial Children's Hospital, Hefei, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.