Significance of Interleukin-6 (IL-6) and C-reactive Protein (CRP) in Children and Young Adults With Febrile Neutropenia During Chemotherapy for Cancer

Chaudhary, Natasha; Kosaraju, Kranthi; Bhat, Kamalakshi G.; Bairy, Indira; Borker, Anupama

doi:10.1097/mph.0b013e3182677fc6

Cited by 20 publications

(17 citation statements)

References 32 publications

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“…CRP was the most frequently studied host biomarker in this review and the majority of these studies (33/36; 92%) reported statistically significant differences in CRP levels measured in patients with bacterial and those with non-bacterial infections ( Table 2 ) [ 20 , 22 – 24 , 26 , 28 – 32 , 34 – 38 , 40 – 42 , 44 , 46 – 50 , 52 – 62 ]. Half of the studies (18/36; 47%) reported sensitivity and specificity at ranges of 61.2%-100% and 26%-100% respectively to identify bacterial infections [ 20 , 22 – 24 , 26 , 28 , 29 , 31 , 34 , 37 , 40 , 42 , 48 , 50 , 53 , 56 , 58 , 60 ].…”

Section: Resultsmentioning

confidence: 99%

Host Biomarkers for Distinguishing Bacterial from Non-Bacterial Causes of Acute Febrile Illness: A Comprehensive Review

et al. 2016

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BackgroundIn resource limited settings acute febrile illnesses are often treated empirically due to a lack of reliable, rapid point-of-care diagnostics. This contributes to the indiscriminate use of antimicrobial drugs and poor treatment outcomes. The aim of this comprehensive review was to summarize the diagnostic performance of host biomarkers capable of differentiating bacterial from non-bacterial infections to guide the use of antibiotics.MethodsOnline databases of published literature were searched from January 2010 through April 2015. English language studies that evaluated the performance of one or more host biomarker in differentiating bacterial from non-bacterial infection in patients were included. Key information extracted included author information, study methods, population, pathogens, clinical information, and biomarker performance data. Study quality was assessed using a combination of validated criteria from the QUADAS and Lijmer checklists. Biomarkers were categorized as hematologic factors, inflammatory molecules, cytokines, cell surface or metabolic markers, other host biomarkers, host transcripts, clinical biometrics, and combinations of markers.FindingsOf the 193 citations identified, 59 studies that evaluated over 112 host biomarkers were selected. Most studies involved patient populations from high-income countries, while 19% involved populations from low- and middle-income countries. The most frequently evaluated host biomarkers were C-reactive protein (61%), white blood cell count (44%) and procalcitonin (34%). Study quality scores ranged from 23.1% to 92.3%. There were 9 high performance host biomarkers or combinations, with sensitivity and specificity of ≥85% or either sensitivity or specificity was reported to be 100%. Five host biomarkers were considered weak markers as they lacked statistically significant performance in discriminating between bacterial and non-bacterial infections.DiscussionThis manuscript provides a summary of host biomarkers to differentiate bacterial from non-bacterial infections in patients with acute febrile illness. Findings provide a basis for prioritizing efforts for further research, assay development and eventual commercialization of rapid point-of-care tests to guide use of antimicrobials. This review also highlights gaps in current knowledge that should be addressed to further improve management of febrile patients.

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Section: Resultsmentioning

confidence: 99%

Host Biomarkers for Distinguishing Bacterial from Non-Bacterial Causes of Acute Febrile Illness: A Comprehensive Review

et al. 2016

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“…In a similar study, PCT and IL-6 were both significant independent predictors of severe sepsis and were superior to CRP 60 . More studies have been published in pediatric patients with suspected sepsis which concluded that IL-6 levels might be helpful for the diagnosis of sepsis 61 - 65 . However, a conclusive study with large sample size is also missing for this patient population.…”

Section: Biomarkersmentioning

confidence: 90%

Rapid diagnosis of sepsis

2013

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Fast and appropriate therapy is the cornerstone in the therapy of sepsis. However, the discrimination of sepsis from non-infectious causes of inflammation may be difficult. Biomarkers have been suggested to aid physicians in this decision. There is currently no biochemical technique available which alone allows a rapid and reliable discrimination between sepsis and non-infectious inflammation. Procalcitonin (PCT) is currently the most investigated biomarker for this purpose. C-reactive protein and interleukin 6 perform inferior to PCT in most studies and their value in diagnosing sepsis is not defined. All biomarkers including PCT are also released after various non-infectious inflammatory impacts. This shortcoming needs to be taken into account when biomarkers are used to aid the physician in the diagnosis of sepsis. Polymerase chain reaction (PCR) based pathogen detection may improve time to adequate therapy but cannot rule out the presence of infection when negative.

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“…In studies in which CRP levels were evaluated by focus of infection in febrile neutropenia, Fleischhack et al (34) found that CRP levels were significantly higher in subjects with Gram-negative bacteremia compared with the FUO group, and similar to the subjects with CDIs. Chaudhary et al (35) found that CRP values on the first day of febrile neutropenia did not show a difference between groups, but were significantly higher on the third day in MDIs compared with the other groups. Tezcan et al (27) could show no difference between MDIs and microbiologically unconfirmed infections in terms of CRP levels.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients

Kar¹,

Özdemir²,

Bör³

2018

Turk Pediatri Ars

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Aim: Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The objective of this study was to evaluate febrile neutropenic episodes in children with malignancy. Material and Methods:Sixty-eight children who received chemotherapy for malignancy between 2010 and 2015 were retrospectively reviewed. The demographic characteristics, laboratory data, infection foci, and frequency of microorganisms grown in culture were examined. Also, the frequency of febrile neutropenic attacks was investigated according to the chemotherapy periods.Results: Of the total 200 episodes, 81 (40.5%) were clinically documented, and 73 (36.5%) were microbiologically documented infections. Fever of unknown origin was observed in 46 (23%) episodes. The most frequently clinically documented focus were mucositis (33.4%) and pneumonia (24.7%). Blood culture was positive in 55 (75.3%) episodes of microbiologically documented infections. The most commonly isolated microorganisms in blood culture were Gram-negative bacteria (47.2%). C-reactive protein levels in microbiologically documented infections were higher than in clinically documented infections, and fever of unknown origin (p<0.05, for both). The most common underlying malignancy was acute lymphoblastic leukemia (73.5%). The highest proportions (34.6%) of febrile neutropenic episodes were observed during the reinduction period for these children. Nine (13.2%) children died of neutropenic sepsis. Conclusions:Febrile neutropenia continues to be an important cause of mortality in pediatric patients with malignancy. C-reactive protein levels may be an indicator for predicting bacterial infection in children with febrile neutropenia without apparent focus. The most frequently isolated agents in our center were Gram-negative microorganisms. Determining the microbial flora of each center may be beneficial to improving survival rates.

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Significance of Interleukin-6 (IL-6) and C-reactive Protein (CRP) in Children and Young Adults With Febrile Neutropenia During Chemotherapy for Cancer

Abstract: Low level of IL-6 may help differentiate patients with FUO from those with documented infections. A rising CRP is indicative of serious infection.

Cited by 20 publications

References 32 publications

Host Biomarkers for Distinguishing Bacterial from Non-Bacterial Causes of Acute Febrile Illness: A Comprehensive Review

Host Biomarkers for Distinguishing Bacterial from Non-Bacterial Causes of Acute Febrile Illness: A Comprehensive Review

Rapid diagnosis of sepsis

Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients

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