Biomarkers and Fever in Children with Cancer: Kinetics and Levels According to Final Diagnosis

Abstract

We investigated the kinetics of CRP, PCT, IL-6 and MR-proADM in a cohort of consecutive febrile patients with cancer in order to test the hypothesis that higher plasma concentrations and the absence of a rapid decrease in peak values would be associated with disease severity. (1) Method: A prospective descriptive and analytical study of patients with cancer and fever (≤18 years of age) at a University Hospital was carried out between January 2018 and December 2019. Information collected: sex, age, diagnosis, date and symptoms at diagnosis and medical history. The episodes were classified into three groups: bacterial infection, non-bacterial infection and systemic inflammatory response syndrome (SIRS). (2) Results: One hundred and thirty-four episodes were included. Bacterial infection criteria were met in 38 episodes. Biomarkers were measured at four different points: baseline, at 12–24 h, at 25–48 h and at 49–72 h. All the biomarkers evaluated decreased after the peak level was reached. IL-6 and MR-proADM showed a trend towards higher levels in the SIRS group although this rise was statistically significant only for IL-6 (p < 0.005). Bacterial infections more frequently presented values of PCT above the cut-off point (>0.5 ng/mL) at 12–24 h. (3) Conclusion: In our experience, IL-6 kinetics is faster than PCT kinetics and both are faster than CRP in patients with fever and cancer who present a good outcome. Patients with a good evolution show a rapid increase and decrease of PCT and particularly of IL-6 levels.

Protocol for the diagnostic performance of C reactive protein, procalcitonin and interleukin-6 for serious bacterial infections among children ≤36 months old presenting with fever without source: a systematic review and meta-analysis

“…Indeed, multiple studies have assessed the role of biomarkers in predicting SBIs in these children. 9 32 …”

Assessment value of interleukin‐6, procalcitonin, and C‐reactive protein early kinetics for initial antibiotic efficacy in patients with febrile neutropenia: A prospective study

“…16,17 In this study, we advanced the observation time to 12 h, finding that unlike IL-6 was consistently at high levels in the IAI group, IL-6 reduced obviously at the early stage of anti-infection (12 h) in the IAE group, which is similar to the study reported by Delgado et al, revealing that IL-6 reached to a peak value at the onset of fever, followed by a decrease on the second day (12-24 h). 15 This similarity may be due to the low likelihood of complications in patients who respond quickly to initial antibiotics. Further analysis using the ROC curve found that the AUC of IL-6 to distinguish the effectiveness of anti-infection at 12 h was 0.895, whereas PCT and CRP were failed to predict the antimicrobial efficacy, which may be associated with the unique characteristics of these three biomarkers.…”

“…17 However, in our study, the concentration of CRP remained at high level in the IAI group, but decreased significantly 24 h after antiinfection in IAE group, which is similar to previous studies, demonstrating that CRP rapidly decreased after reaching its peak in anti-infection effective group. 8,15 This difference may be associated with the low specificity of CRP, which is not only produced in infected patients, but affected by the disease severity in patients. In this study, the distinguished kinetic of CRP in patients with different therapeutic efficacy may be due to the fact that the enrolled population is largely non-critical patients, and the CRP changes are only affected by the infectious pathogens.…”

“…[10][11][12][13][14] However, the function of IL-6, PCT and CRP in predicting antibiotic efficacy is far from clear, especially in FN patients. 15 Herein, we conducted a prospective study to investigate whether IL-6, PCT, and CRP can be used to evaluate initial antibiotic efficacy of FN patients with hematological disorder through observing the early kinetic changes in these three biomarkers.…”

“…Under infection, interleukin 6 (IL‐6) usually appears in plasma at 30 min to 2 h after stimulation, reaches its peak at 4–6 h, and has a half‐life of about 4–6 h; Procalcitonin (PCT) usually appeared in plasma 2 to 3 h after stimulation, reached its peak at 12 to 24 h after infection, and its half‐life was about 20 to 28 h; C‐reactive protein (CRP), however, often appears in plasma at 6 to 8 h after stimulation, reaches its peak at 24 to 48 h, and has a half‐life of 19 h. For decades, interleukin 6 (IL‐6), procalcitonin (PCT), and C‐reactive protein (CRP) have been widely investigated to identify pathogenic bacteria, evaluate the severity of infection, and predict adverse outcomes in cancer patients 10–14 . However, the function of IL‐6, PCT and CRP in predicting antibiotic efficacy is far from clear, especially in FN patients 15 . Herein, we conducted a prospective study to investigate whether IL‐6, PCT, and CRP can be used to evaluate initial antibiotic efficacy of FN patients with hematological disorder through observing the early kinetic changes in these three biomarkers.…”