The predictive value of procalcitonin, C-reactive protein, presepsin, and soluble-triggering receptor expressed on myeloid cell levels in bloodstream infections in pediatric patients with febrile neutropenia

Abstract

Ö. The predictive value of procalcitonin, C-reactive protein, presepsin, and soluble-triggering receptor expressed on myeloid cell levels in bloodstream infections in pediatric patients with febrile neutropenia. Turk J Pediatr 2019; 61: 359-367. The present study investigates the predictive value of procalcitonin (PCT), C-reactive protein (CRP), presepsin (PRE-SEP) and soluble-triggering receptor, as expressed on myeloid cells (sTREM-1) levels in bloodstream infections in pediatric patients with febrile neutropenia. A total of 47 episodes of febrile neutropenia that developed in 30 children with malignancy were analyzed in this study, while the control group comprised 27 children who had undergone chemotherapy for malignancy (completed ≥2 years ago) without neutropenia, fever or drug use. Median PCT, CRP, PRE-SEP and sTREM-1 levels on admission were found to be significantly higher in the patient group than in the control group, while in the blood cultures, the microbiological agent was isolated in 13 (27.7%) of the 47 episodes. Median PCT and CRP levels on days 1, 2 and 7 were higher in the blood culture-positive episodes than in the blood culture-negative episodes. There was no significant difference in the PRE-SEP and sTREM-1 levels on days 1, 2 and 7 between the blood culture-positive and blood culture-negative episodes. The results of the study suggest that PRE-SEP and sTREM-1 are at measurable levels upon admission in children with febrile neutropenia, but that these markers may not be appropriate for the predicting of bloodstream infections, although CRP and PCT levels within the first 24 hours may serve as a guide for clinicians.

The role of presepsin in pediatric patients with oncological and hematological diseases experiencing febrile neutropenia

“…Presepsin levels found in patients with FN were significantly higher than the values found in the control group. The increase of presepsin levels in patients with severe leukopenia, alongside with lack of correlation between presepsin levels and circulation leukocyte count, suggests that presepsin may be produced by other cell types [29][30][31] . Among the cells that are thought to contribute to the production of presepsin, hepatocytes seem the most plausible hypothesis, together with resident monocytes and tissue macrophages [32][33][34] 34,38 .…”

Triggering receptor expressed on myeloid cells-1 as pediatric sepsis biomarker

“…Of the studies included, four used TREM-1 as a predictive biomarker 9,11,14,15 , four used it for diagnosis purposes 6,10,12,13 , and two, as a prognostic marker 16,17 of sepsis in pediatric patients. As for the type of study, eight were primary surveys [9][10][11][12][13][15][16][17] and two were systematic reviews 6,14 . As for the LE, five papers were classified as 2C 9,10,12,13,17 , three as 3B 11,15,16 , and two as 2A 6,14 .…”

“…As for the type of study, eight were primary surveys [9][10][11][12][13][15][16][17] and two were systematic reviews 6,14 . As for the LE, five papers were classified as 2C 9,10,12,13,17 , three as 3B 11,15,16 , and two as 2A 6,14 . As for the number of patients involved, there were 1,409 in the primary studies [9][10][11][12][13][15][16][17] and 1,628 6,14 in the review studies.…”

“…As for the interpretative analysis of primary study results, only one 15 suggested that TREM-1 levels are not appropriate for detecting infections. The others [9][10][11][12][13]16,17 showed significant results that validated the use of TREM-1 levels in the prediction, diagnosis, and prognosis of sepsis in children.…”

“…However, it was not possible to obtain quantitative results due to the small number of studies, which included heterogeneous populations. Özdemir et al 15 found no significant difference in TREM-1 levels at days 1, 2, and 7 between patients with positive or negative blood culture results. The results suggest that TREM-1 is present at measurable levels on admission in children with febrile neutropenia, but it may not be appropriate to predict bloodstream infections.…”