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

Arif, Tasnim; Phillips, Bob

doi:10.1002/pbc.27887

“…Current knowledge of PCT role in immunocompromised children is scarce (30)(31)(32)(33)(34). Previous reports in children with cancer showed that PCT is an effective biomarker of sepsis during a fever and neutropenia episode; however, none of them evaluate the role of PCT to predict blood culture results (30,34).…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin levels in children with bloodstream infections caused by different species: a cohort study

Bejarano

¹

,

Ranero

²

,

Tamez-Rivera

³

et al. 2020

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Abstract Background: Timely diagnosis and accurate identification of the causative microorganism in sepsis is crucial in order to offer directed treatment and increase survival rates. Previous studies have aimed to identify biomarkers that could potentially predict blood culture positivity in patients with bacteremia; however, most of the research has been performed in adult populations. The aim of this study were to analyze procalcitonin levels in confirmed bloodstream infections by species in children and assess its utility in immunocompromised patients. Methods: We included children who met the diagnostic criteria for sepsis, with PCT levels collected within a 72-hour period prior to obtaining a blood culture. Kruskal-Wallis test was used to compare differences among groups. Receiver-operating characteristic curves were used to evaluate PCT cut-offs. Results: 120 patients were included, mean age of 55 months. Subjects with immunodeficiency mean PCT was 26.68 mcg/L, compared to 8.78 in immunocompetent hosts. Subjects with Gram-negative bacilli (GNB) had the highest mean PCT levels (18.2 ± 34.2). The difference among microorganisms was significant. Sensitivity and specificity were 78% and 53% for Gram-positive cocci, 60.9% and 33.3% for GNB, and 75% with 25% for yeasts. Subgroup analysis showed 87.5% sensitivity and 16.7% specificity of PCT for predicting GNB blood culture in immunodeficiency children. Conclusions: PCT could be considered as a surrogate biomarker in immunocompromised children and a viable tool to differentiate etiology by species. Key words: Procalcitonin; Sepsis; Bacterial sepsis

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“…Studies on PCT in immunocompromised patients are scarce (30)(31)(32)(33)(34). A recent systematic review and meta-analysis in children with chemotherapy-induced neutropenic fever showed that PCT levels > 0.5 ng/mL have a 67% sensitivity (CI 0.53-0.79), and 73% specificity (CI 0.66-0.77) for predicting microbiologically defined infections (34). In our study according to mean PCT levels, we found a statistically significant difference between immunocompromised (26.68 mcg/L) and immunocompetent (8.78 mcg/L) children with sepsis (p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin levels in children with bloodstream infections caused by different species: a cohort study

Bejarano

¹

,

Ranero

²

,

Tamez-Rivera

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Timely diagnosis and accurate identification of the causative microorganism in sepsis is crucial in order to offer targeted treatment and increase survival rates. Previous studies have aimed to identify biomarkers that could potentially predict blood culture positivity in patients with bacteremia; however, most of the research has been performed in adult populations. The aims of this study were to analyze procalcitonin (PCT) levels in confirmed bloodstream infections by species in children and assess their utility in immunocompromised patients.Methods: Medical records of children younger than 18 years admitted from 2011 to 2018 were reviewed. Subjects who met the diagnostic criteria for sepsis, with PCT levels collected within a 72-hour period prior to obtaining a blood culture were included. Kruskal-Wallis test was used to compare differences among groups. Receiver-operating characteristic curves were used to evaluate PCT cut-offs. Results: A total of 120 patients were included. Mean age was 55 months. Mean PCT levels in immunosuppressed patients was 26.68 mcg/L, compared to 8.78 in the immunocompetent group. Subjects with bacteremia by Gram-negative bacilli (GNB) had the highest mean PCT levels (18.2 ± 34.2) (p < 0.001). Sensitivity and specificity were 78% and 53% for Gram-positive cocci (GPC), 60.9% and 33.3% for GNB, and 75% and 25% for yeasts, respectively. Subgroup analysis showed 87.5% sensitivity and 16.7% specificity of PCT for predicting documented GNB bacteremia in immunodeficient children. Conclusions: PCT may be considered as a surrogate biomarker in immunocompromised children, and a viable tool to differentiate etiology by species.

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“…Studies on PCT in immunocompromised patients are scarce (30)(31)(32)(33)(34). A recent systematic review and meta-analysis in children with chemotherapy-induced neutropenic fever showed that PCT levels >0.5ng/mL have a 67% sensitivity (CI 0.53-0.79), and 73% speci city (CI 0.66-0.77) for predicting microbiologically de ned infections (34). In our study according to mean PCT levels, we found a statistically signi cant difference between immunocompromised (26.68 mcg/L) and immunocompetent (8.78 mcg/L) children with sepsis (p <0.05).…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin levels in children with bloodstream infections caused by different species: a cohort study

Bejarano¹,

Ranero²,

Tamez-Rivera³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Timely diagnosis and accurate identification of the causative microorganism in sepsis is crucial in order to offer targeted treatment and increase survival rates. Previous studies have aimed to identify biomarkers that could potentially predict blood culture positivity in patients with bacteremia; however, most of the research has been performed in adult populations. The aims of this study were to analyze procalcitonin (PCT) levels in confirmed bloodstream infections by species in children and assess their utility in immunocompromised patients.Methods: Medical records of children younger than 18 years admitted from 2011 to 2018 were reviewed. Subjects who met the diagnostic criteria for sepsis, with PCT levels collected within a 72-hour period prior to obtaining a blood culture were included. Kruskal-Wallis test was used to compare differences among groups. Receiver-operating characteristic curves were used to evaluate PCT cut-offs. Results: A total of 120 patients were included. Mean age was 55 months. Mean PCT levels in immunosuppressed patients was 26.68 mcg/L, compared to 8.78 in the immunocompetent group. Subjects with bacteremia by Gram-negative bacilli (GNB) had the highest mean PCT levels (18.2 ± 34.2) (p < 0.001). Sensitivity and specificity were 78% and 53% for Gram-positive cocci (GPC), 60.9% and 33.3% for GNB, and 75% and 25% for yeasts, respectively. Subgroup analysis showed 87.5% sensitivity and 16.7% specificity of PCT for predicting documented GNB bacteremia in immunodeficient children. Conclusions: PCT may be considered as a surrogate biomarker in immunocompromised children, and a viable tool to differentiate etiology by species.

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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

Cited by 39 publications

References 47 publications

Procalcitonin levels in children with bloodstream infections caused by different species: a cohort study

Procalcitonin levels in children with bloodstream infections caused by different species: a cohort study

Procalcitonin levels in children with bloodstream infections caused by different species: a cohort study

Procalcitonin levels in children with bloodstream infections caused by different species: a cohort study

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