{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:49:56Z","timestamp":1791355796084,"version":"4.3.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to develop a predictive model for cytarabine syndrome (CS)-related fever in pediatric patients with acute lymphoblastic leukemia (ALL). By integrating clinical features and laboratory indicators, we seek to establish an evidence-based diagnostic tool to assist clinicians in decision-making and optimize the use of antimicrobial agents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Study Design: A retrospective case-control study was conducted involving 72 ALL children (32 in the CS group vs. 40 in the infection group) who developed fever (\u226537.5\u2005\u00b0C) following cytarabine treatment. Model Development: Multivariate logistic regression was used to identify independent predictors. A nomogram was constructed. The model's discriminative ability was evaluated using the receiver operating characteristic (ROC) curve, calibration was assessed via the Hosmer-Lemeshow test, and clinical utility was validated using decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key Predictors: Multivariate analysis revealed that BSA (OR\u2009=\u20090.01, 95% CI: 0.00\u20130.17) and hs-CRP (OR\u2009=\u20090.84, 95% CI: 0.72\u20130.97) were the most significant predictors of CS. Model Performance: The ROC analysis demonstrated an AUC of 0.785, with internal validation via 1000 bootstrap resamples yielding a 95% confidence interval of 0.675\u20130.882. The calibration curve demonstrated excellent agreement between predicted and observed outcomes (MAE\u2009=\u20090.039). Decision curve analysis indicated that the model provided superior net benefits across most threshold probabilities (0.2\u20130.8) compared to strategies of universal antibiotic use or no intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The developed predictive model demonstrates high discriminative performance and robust clinical applicability, functioning as an effective quantitative instrument for early identification of cytarabine syndrome (CS) and facilitating evidence-based antibiotic stewardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1957986","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:53:37Z","timestamp":1791352417000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A predictive model for cytarabine syndrome-associated febrile episodes in children with acute lymphoblastic leukemia"],"prefix":"10.3389","volume":"14","author":[{"given":"Zheng","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Shenzhen Children's Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixiang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Shenzhen Children's Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Shenzhen Children's Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangyuan","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Shenzhen Children's Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zebin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Shenzhen Children's Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feiqiu","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Shenzhen Children's Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huirong","family":"Mai","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Shenzhen Children's Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuejuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Shenzhen Children's Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"41","DOI":"10.6004\/jnccn.2025.0006","article-title":"Pediatric acute lymphoblastic leukemia, version 2.2025, NCCN clinical practice guidelines in oncology","volume":"23","author":"Inaba","year":"2025","journal-title":"J Natl Compr Canc Netw"},{"key":"B2","doi-asserted-by":"publisher","first-page":"563","DOI":"10.6004\/jnccn.2024.0051","article-title":"Acute lymphoblastic leukemia, version 2.2024, NCCN clinical practice guidelines in oncology","volume":"22","author":"Shah","year":"2024","journal-title":"J Natl Compr Cancer Network"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2606","DOI":"10.1080\/10428194.2019.1605071","article-title":"Recent advances in the treatment of acute lymphoblastic leukemia","volume":"60","author":"Rafei","year":"2019","journal-title":"Leuk Lymphoma"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e28131","DOI":"10.1002\/pbc.28131","article-title":"Surge of serum interleukin-2 level in a Japanese patient with cytarabine syndrome","volume":"67","author":"Iida","year":"2020","journal-title":"Pediatr Blood Cancer"},{"key":"B5","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1002\/mpo.2950090309","article-title":"The cytosine arabinoside (ara-C) syndrome","volume":"9","author":"Castleberry","year":"1981","journal-title":". 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