Do Proinflammatory Cytokine Levels Predict Serious Complication Risk of Infection in Pediatric Cancer Patients?

Abstract

Determination of risk of severe bacterial infection complication in children with cancer is important to diminish the cost of hospitalization and therapy. In this study, children with cancer (leukemia excluded) were evaluated for risk of severe infection complication, success of therapy and the relation between clinical and inflammatory parameters during neutropenic fever attacks. Children who fulfilled the criteria of neutropenic fever with cancer were enrolled in the study. During admission, together with clinical and laboratory parameters; interleukin-6, interleukin-8, soluble tumor necrosis factor receptor II, and soluble interleukin 2 reseptor ve procalcitonin levels were detected. Empirical therapy was started with piperacillin/tazobactam and relation between the inflammatory cytokine levels and therapy response parameters were evaluated. The study population included 31 children and 50 neutropenic attacks were studied. In 48% of the attacks, absolute neutrophile count was >100/mm(3) and infectious agents were shown microbiologically in 12% of the attacks. In the study group with piperacillin/tazobactam monotherapy, the success rate without modification was 58%. In the therapy modified group mean duration of fever, antibiotherapy and hospitalization were significantly longer than the group without modification. Inflammatory cytokines' levels during admission (interleukin-6, interleukin-8, soluble tumor necrosis factor reseptor II) were higher in patients with fever >3 days and in multiple regression analysis, it has been shown that they have a determinative role on fever control time. Other cytokines did not show any significant relationship with risk of severe bacterial infection complication and success of therapy.

The diagnostic and prognostic value of angiopoietins compared with C-reactive protein and procalcitonin in children with febrile neutropenia

“…They also found that PCT levels were lower in patients with fever of unknown origin when compared with proven infection. Karakurt DG et al 2 did not find IL-6, IL-8, sTNFRII, sIL-2R, CRP, and PCT levels as significant predictors of serious infectious complication in pediatric cancer patients' admission for febrile neutropenia. The concentration of lipopolysaccharidebinding protein (LBP), PCT, interleukin-6, and CRP was determined for 90 episodes of FN by Kitanovski et al 31 The concentrations of all biomarkers were significantly higher in patients with bacteremia/clinical sepsis than non-bacteremia/clinical sepsis episodes on admission and day 2.…”

“…To determine the intensity of needed treatments and to decrease the mortality rates, risk classifications were made; and these classifications were based on the measurements of C-reactive protein (CRP), procalcitonin (PCT), and interleukin 6 (IL-6) biomarkers. [2][3][4][5] CRP and PCT have been reported to be guiding tools for both the prediction of infection and the arrangement of treatment; thus, they are used prevalently. [6][7][8] Despite all of these biomarkers, severity of infection and risk of mortality cannot be fully determined.…”

Sepsis-related acute respiratory distress syndrome in children with cancer: the respiratory dynamics of a devastating condition

“…Despite the great depletion in granulocytes, lymphocytes and monocytes, patients receiving chemotherapy are able to maintain elevated levels of inflammatory cytokines in sepsis, particularly interleukins 6 and 8; (13) this suggests that production and excretion by macrophages and dendritic cells are preserved. By receiving almost the totality of cardiac output, lungs are exposed to a great number of inflammatory mediators secreted by these cells in peripheral organs, in addition to the local production by alveolar macrophages and activated endothelial cells.…”

C-reactive protein and other biomarkers—the sense and non-sense of using inflammation biomarkers for the diagnosis of severe bacterial infection

“…Classical markers like PCT and CRP as well as their soluble receptors (IL-6, IL-8, IL-2 receptor and tumor necrosis factor receptor) cannot differentiate between bacterial and viral infections in children and adults with fever and cytopenia. Moreover, they are not helpful for monitoring the course of patients with fever and cytopenia and are thus regarded as non-relevant (Lin et al 2012;Phillips et al 2012;Haeusler et al 2013;Karakurt et al 2014). The care of children with oncology diseases may change in the future with the advent of novel technologies to detect and monitor infections.…”