"Predictive Potential of Interleukin-6, Pentraxin-3, and Procalcitonin in Identifying Sepsis and Septic Shock Among High-Risk Fever and Neutropenia Pediatric Cancer Patients Running Head: Biomarkers Predictive Value for Septic Shock"

Abstract

Background: This study aimed to assess the role of interleukin-6(IL-6), Pentraxin-3(PTX-3), and procalcitonin (PCT) in predicting pediatric cancer patients who may develop sepsis or septic shock.Aim: The study aimed to determine which biomarker has the highest diagnostic value for sepsis/septic shock and to analyze the correlation of the biomarkers with the severity of organ dysfunction represented by the pediatric sequential organ failure assessment (PSOFA) scores.Methods: Serum levels of interleukin-6, Pentraxin-3, and procalcitonin were measured in 86 pediatric cancer patients who presented with FN, sepsis, and septic shock. Blood samples for IL-6, PTX3, and PCT were obtained within 6 hours of presentation. Patients were categorized into septic and non-septic groups and PSOFA scores at D1, D3, and D28 were calculated. Optimal cut-off values for sepsis and prognostic PSOFA scores were determined.Results: IL-6, as a single biomarker had the highest ability to predict sepsis at a cut-off value of 89.8 pg/mL with 100% sensitivity and 60.3% specificity (P value <0.001). Combining biomarkers increased the sensitivity and specificity for predicting septic shock and mortality at D28. There was a positive relationship between delta PSOFA and in-hospital mortality. The median levels of IL-6, PTX3, and procalcitonin in gramnegative MDR septic shock patients were significantly higher than the medians in septic shock patients without gram-negative MDR (P value was < 0.05). Conclusion:Novel biomarkers can help predict sepsis and guide protocols for managing high-risk fever and neutropenia.