Table 4.
Sensitivity, specificity, positive predictive value and negative predictive value of derivation study (d) and prospective validation (Pv) cohort at febrile neutropenia presentation.
| Rule | Epi-sodes | Out-come, n (%) | Low risk, n (%) | AUC (95% CI) | Sensitivity |
Specificity |
PPV,% (95% CI) | NPV,% (95% CI) | LR | ||
|---|---|---|---|---|---|---|---|---|---|---|---|
| % (95% CI) | Dif from deriv.% (p value) | % (95% CI) | Dif from deriv.% (p value) | ||||||||
| Rules predicting microbiologically defined infection | |||||||||||
| d-PICNICC [8] | 909 | 236 (26·0) | 163 (17·9) | – | 91.5 (87·3–94·4) | – | 21·2 (18.3–24·5) | – | 29 (25·8–32·2) | 87·7 (81·8–91·9) | 1·2 |
| Pv-PICNICC | 858 | 296 (34·5) | 155 (18·1) | 0·56 (0·53–0·60) | 87·2 (82·9–90·5) | 4·3 (0·12) | 20·8 (17·7–24·4) | 0·4 (0·89) | 36·7 (33·2–40·3) | 75·5 (68·2–81·6) | 1·1 |
| Rules predicting adverse outcome | |||||||||||
| d-SPOG AE [21] | 423 | 122 (28·2) | 165 (39) | NA | 91·8* (85·6–95·5) | – | 51·5 (45·9–57·1) | – | 43·3 (37·5–49·5) | 93·9 (89·2–96·7) | 1·9 |
| Pv-SPOG AE | 858 | 320 (37·3) | 329 (38·3) | 0·54 (0·51–0·58) | 72·2* (67·0–76·8) | 19·6 (<0·001) | 44·6 (40·5–48·8) | 6·9 (0·07) | 43·7 (39·5–47·9) | 73·0 (67·9–77·5) | 1·3 |
| d-Hakim [22] | 323 | 47 (14·6) | 223 (69) | NA | 74·5 (60·5–84·7) | – | 76·4 (71·1–81·1) | – | 35·0 (26·4–44·7) | 94·6 (90·8–96·9) | 3·2 |
| Pv-Hakim | 858 | 151 (17·6) | 693 (80·8) | 0.69 (0·64–0·73) | 41·7 (34·2–49·7) | 32·8 (<0·001) | 85·6 (82·8–88·0) | 9·1 (<0·001) | 38·2 (31·1–45·8) | 87·3 (84·6–89·6) | 2·9 |
| d-Alexander [23] | 104 | 22 (21·2) | 55 (53) | NA | 90·9 (72·2–98·4) | – | 64·6 (53·8–74·1) | – | 40·8 (28·2–54·8) | 96·4 (87·7–99·4) | 2·6 |
| Pv-Alexander | 858 | 306 (35·7) | 354 (41·3) | 0·51 (0·47–0·55) | 63·7 (58·2–68·9) | 27.2 (<0.01) | 44·0 (39·9–48·2) | 20·6 (<0·001) | 38·7 (34·5–43·0) | 68·6 (63·6–73·2) | 1·1 |
| d-Klaassen [24] | 227 | 43 (18·9) | 83 (36·6) | NA | 83·7 (70–91·9) | – | 41·5 (34·6–48·8) | – | 25·3 (18·8–32·9) | 91·6 (83·6–95·9) | 1·4 |
| Pv-Klaassen | 858 | 135 (15·7) | 207 (24·1) | 0·59 (0·55–0·63) | 85·2 (78·2–90·2) | 1·5 (0·81) | 25·9 (22·8–29·2) | 15·7 (<0·001) | 17·7 (14·9–20·8) | 90·3 (85·6–93·7) | 1·2 |
| Rules predicting bacteraemia | |||||||||||
| d-SPOG bacteraemia [28] | 423 | 67 (15·8) | 54 (12·8) | NA | 100* (94·6–100) | – | 15·2 (11.8–19.3) | – | 18·2 (14·6–22·4) | 100 (93.4–100) | 1·2 |
| Pv-SPOG bacteraemia | 858 | 111 (12·9) | 133 (15·5) | 0·63 (0·58–0·69) | 94·6* (88·7–97·5) | 5·4 (0·8) | 17·1 (14·6–20·0) | 1·9 (0·44) | 14.5 (12.1–17.3) | 95.5 (90.6–97.9) | 1·1 |
| d-Ammann [27] | 348 | 85 (24) | 100 (28·7) | NA | 95·3 (88·5–98·2) | – | 36·5 (30·9–42·5) | – | 3·7 (27·1–38·7) | 96·0 (90.2–98.4) | 1·5 |
| Pv-Ammann | 858 | 111 (12·9) | 139 (16·2) | 0·57 (0·54–0·59) | 95·5 (89·9–98·1) | 0·2 (>0·99) | 17·9 (15·4–20·9) | 18·6 (<0·001) | 14·7 (12·3–17·5) | 96·4 (91.9–98.5) | 1·2 |
| d-Baorto [25] | 1171 | 189 (16·1) | 164 (14) | NA | 94·7 (90·5–97·1) | NA | 15·7 (13·5–18·1) | NA | 17·8 (15·5–20·3) | 93·9 (89·1–96·7) | 1·1 |
| Pv-Baorto | 858 | 111 (12·9) | 148 (17·2) | 0·59 (0·56–0·62) | 93·7 (87·6- 96·9) | 1.0 (0.80) | 18·9 (16·2–21·8) | 3·2 (0·08) | 14·6 (12·2–17·4) | 95·3 (90·5–97·7) | 1·2 |
| d-Rackoff [26] | 115 | 24 (20·9) | 94 (81·7) | NA | 41·7 (24·5–61·2) | – | 87·9 (79·6–93·1) | – | 47·6 (28·3–67·6) | 85·1 (76·5–90·9) | 3·5 |
| Pv-Rackoff⁎⁎ | 858 | 111 (12·9) | 691 (80·5) | 0·63 (0·59–0·69) | 35·1 (26·9–44·4) | 6·5 (0·64) | 82·9 (80·0–85·4) | 5·0 (0·30) | 23·4 (17·6–30·3) | 89·6 (87·1–91.6) | 2·1 |
| Pv-Rackoff⁎⁎⁎ | 858 | 111 (12·9) | 207 (24·1) | – | 91·0 (84·2–95·0) | NA | 26·4 (23·3–29·7) | NA | 15·5 (12·9–18·5) | 95·2 (91·3–97·4) | 1·2 |
d, derivation study; Pv, prospective validation; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; LR, likelihood ratio; Dif from deriv, difference from derivation study.
⁎
includes episodes with adverse event known at reassessment.
⁎⁎
intermediate and low risk combined into a single low-risk group.
⁎⁎⁎
intermediate and high-risk combined into a single high-risk group.