Predictive value of PCT and IL-6 for bacterial infection in children with cancer and febrile neutropenia

Abstract

PurposeOnly a third of children with cancer and febrile neutropenia (FN) have a proven bacterial infection; nevertheless, most children are hospitalized and treated with intravenous antibiotics. Several biomarkers have been proposed as predictive markers for bacterial infection in this population. We aimed to evaluate the role of interleukin-6 (IL-6) and procalcitonin (PCT) in diagnosing bacterial infection in children with cancer and FN.MethodsThe study population was derived from a prospective database (2006–2013, IL-8 study) comprising children with cancer who presented with FN. From stored plasma samples (taken at admission and/or at 12–24 h), we determined the PCT and IL-6 levels. Consequently, we explored their relation with the presence of bacterial infection (positive blood culture, radiologically documented infection or clinical bacterial focus). We predefined cutoff values at 60 ng/L for IL-6 and 0.25 ng/mL for PCT.ResultsSeventy-seven FN episodes in 55 children with cancer were included. In 18 episodes (23.4%), a bacterial infection was documented. Both at presentation and after 12–24 h, median values of IL-6 and PCT were significantly higher in patients with a bacterial infection compared to patients without a bacterial infection. With both biomarkers above cutoff values, sensitivity was 93% (with either one, this was even 100%). The identified group at low risk for bacterial infection comprised 41% of the population.ConclusionPCT and IL-6 are promising markers in identifying bacterial infection in children with cancer and FN. In a subsequent project, we will incorporate these biomarkers in a risk assessment model that we will test prospectively in a clinical trial.

Updated systematic review and meta‐analysis of the predictive value of serum biomarkers in the assessment and management of fever during neutropenia in children with cancer

“…Thirteen studies in this review used more than one biomarker and gave comparative descriptions of performance . Three out of the four studies comparing the performance of CRP and PCT found the latter to be better at predicting adverse outcomes.…”

“…Five studies explored the predictive role of IL‐6 and IL‐8: one found IL8 to perform better, one found them to be equivalent, and the other three did not make any comparisons . There were no direct comparisons of PCT with IL‐8 but one study compared the predictive value of PCT to IL‐6, finding that IL‐6 demonstrated better discriminatory power at admission and at 12‐24 h of admission but particularly at admission. The authors also found combining PCT (>0.25 ng/L) with IL‐6 (>60 ng/L), which significantly increased the likelihood of identifying a bacterial infection at both time points.…”

First Insights into Clinical and Resistance Features of Infections by Klebsiella pneumoniae among Oncological Patients from a Referral Center in Amazon Region, Brazil

“…Klebsiella pneumoniae stands as one of the most prevalent pathogens among cancer patients and a major complication among those undergoing chemotherapy, with infection and mortality rates due to bacteremia ranging from 10% to 53% and 18% to 30%, respectively [ 1 , 2 , 3 , 4 ]. Worryingly, mortality rates reaching 72.7% have been reported due to the spread of multidrug-resistant (MDR) and carbapenemase-producing K. pneumoniae strains [ 5 , 6 , 7 ].…”

“…Severe and prolonged neutropenia induced by chemotherapy is the main risk factor for the acquisition of serious infections, including those caused by MDR pathogens [ 10 , 11 ]. Moreover, immunocompromised individuals demonstrate few clinical signs in bacterial infections, which are commonly confused with the symptoms of the underlying neoplasm or treatment side effects [ 7 , 10 , 11 ]. Other risk factors that contribute to poor prognosis infections in cancer patients are myeloablative therapy, total body irradiation, high doses of steroids, tissue grafting, prolonged hospitalization, recent surgery, resection of multiple organs, exposed cancer, enteral diet, ostomies, admission to intensive care unit (ICUs), presence of central venous catheter, bladder catheterization, ventilatory assistance, hemodialysis and disease chronic pulmonary disease [ 12 , 13 , 14 , 15 ].…”

Serum biomarkers differentiating Kawasaki disease from febrile infections: A pilot case-control study

“…In the immune system they modulate the balance between humoral and cellular responses. Elevated serum cytokines have also been studied in febrile illnesses associated, or not, with infectious diseases but without direct comparison with KD ( van der Galien et al, 2018 , Chandrashekara et al, 2016 , Zheng et al, 2017 ).…”