Identifying High Risk Typhlitis Patients: SIPA and White Blood Cell Count Trends Associated with Surgical Management and Mortality

Background/Purpose:
Typhlitis is uncommon but can be life-threatening in pediatric cancer patients. The cornerstone is medical management (MM), with surgical intervention reserved for clinical deterioration and/or bowel perforation. We hypothesized that trends in the Shock Index, Pediatric Age-Adjusted (SIPA) and white blood cell (WBC) count could alert practitioners to those patients at greatest risk for surgical intervention and mortality in pediatric cancer patients with typhlitis.

Methods:
A prospectively maintained cancer center registry was retrospectively reviewed for pediatric cancer patients diagnosed with typhlitis between 2006 and 2018. A bioinformatics data pull of all inpatient vital signs and laboratory values was performed. Function-on-scalar (FoS) regression was performed to compare the trends in SIPA and WBC throughout the entire hospital admission until discharge, or the outcomes of mortality or surgical intervention.

Results:
Eighty-three typhlitis patients were identified; 76 were MM and 8 had a laparotomy. In-hospital mortality was 12% in MM and 38% in the surgical cohort. FoS regression results indicated that SIPA values were an average of 0.15 points higher for surgical patients during their hospitalization (up until the time of surgery) and 0.11 points higher for patients who ultimately died in the hospital (p<0.001 for both). FoS regression showed that individuals who underwent surgery had WBCs that were elevated by an average count of 5.21 (p<0.001).

Conclusion:
Our initial results suggest that trends in SIPA and WBC may be helpful in alerting practitioners to those patients who are at increased risk for mortality and may benefit from earlier aggressive interventions. We advocate for serial monitoring of SIPA and WBC counts in pediatric cancer patients who develop typhlitis and future research studies to develop predictive models.