Predictive value of red blood cell parameters for sepsis during chemotherapy-induced neutropenia in children with acute lymphoblastic leukemia based on propensity score matching.

[OBJECTIVE] To investigate the predictive efficacy and clinical application value of red blood cell (RBC) parameters (hemoglobin and red blood cell distribution width) and their combined model for sepsis during chemotherapy-induced neutropenia (CIN) in children with acute lymphoblastic leukemia (ALL), based on propensity score matching (PSM) to eliminate confounding bias between groups.

[METHODS] A retrospective cohort design was adopted. A total of 264 children with ALL who received induction remission chemotherapy according to the South China Children's Leukemia Group-ALL-2016 (SCCLG-ALL-2016) protocol and developed CIN between January 2021 and December 2024 in the Affiliated Hospital of Guangdong Medical University and Huizhou Central People's Hospital were included. The patients were divided into a sepsis group and a CIN group according to clinical outcomes. PSM was used to balance baseline characteristics between groups. Univariate and multivariate logistic regression models were used to screen independent influencing factors for sepsis. Receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the predictive efficacy and incremental value of single indicators and the combined model. Decision curve analysis (DCA) was applied to assess clinical net benefit, and Kaplan-Meier curves were plotted to analyze the cumulative incidence of sepsis under different RDW quartiles.

[RESULTS] A total of 108 patients were included after PSM matching (75 in the CIN group and 33 in the sepsis group). The RDW levels and pediatric Sequential Organ Failure Assessment (pSOFA) scores in the sepsis group were significantly higher than those in the CIN group, while Hb, RBC, and Hct levels were significantly lower ( < 0.05). Multivariate logistic regression analysis showed that RDW (OR = 1.424, 95% CI: 1.150-1.764,  = 0.001) and pSOFA score (OR = 1.613, 95% CI: 1.102-2.361,  = 0.014) were independent risk factors for sepsis, while Hb (OR = 0.974, 95% CI: 0.943-1.006,  = 0.113) was a protective factor. ROC curve analysis showed that the AUC of the combined model (Hb + RDW) for predicting sepsis was 0.812, which was significantly superior to single Hb (AUC = 0.672), RDW (AUC = 0.701), and pSOFA score (AUC = 0.682). Incremental value analysis showed that compared with single RDW, the IDI of the combined model was 0.068 ( = 0.003). DCA confirmed that the combined model provided better clinical net benefit within the threshold range of 10%-60%. Log-rank test indicated that the cumulative incidence of sepsis in the high RDW level group (Q4) was significantly increased ( = 0.024).

[CONCLUSIONS] RBC parameters (RDW, Hb) are independent predictors of sepsis in children with ALL during CIN. The combined prediction model constructed by Hb and RDW can effectively capture early signals of microcirculatory dysfunction, with predictive efficacy and clinical benefit superior to single indicators.