Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia

Doerflinger, Marcel; Haeusler, Gabrielle M; Suen, Connie S. N. Li Wai; Clark, Julia; Slavin, Monica; Babl, Franz E; Allaway, Zoe; Méchinaud, Françoise; Smyth, Gordon K.; Lourenço, Richard De Abreu; Phillips, Bob; Pellegrini, Marc; Thursky, Karin

doi:10.3389/fimmu.2021.641879

Cited by 11 publications

(12 citation statements)

References 34 publications

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“…Sixteen of these (41.6%) found significant associations between elevated CRP and bacterial infection, either microbiologically or clinically confirmed. Moreover, 14/16 significant studies provided predictive data with various cutoff values (range: 5–120 mg/L) ( 6 , 9 , 31 , 33 , 35 , 37 , 39 , 40 , 48 , 53 , 55 , 62 , 63 , 74 ).…”

Section: Resultsmentioning

confidence: 99%

Biomarkers for Diagnosing Febrile Illness in Immunocompromised Children: A Systematic Review of the Literature

2022

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ObjectiveThis study aims to assess the performance of biomarkers used for the prediction of bacterial, viral, and fungal infection in immunocompromised children upon presentation with fever.MethodsWe performed a literature search using PubMed and MEDLINE and In-Process & Other Non-indexed Citations databases. Cohort and case–control studies assessing biomarkers for the prediction of bacterial, viral, or fungal infection in immunocompromised children vs. conventional microbiological investigations were eligible. Studies including adult patients were eligible if pediatric data were separately assessable. Data on definitions used for infections, fever, and neutropenia and predictive values were collected. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsFifty-two studies involving 13,939 febrile episodes in 7,059 children were included. In total, 92.2% were in cancer patients (n = 48), and 15.7% also included hematopoietic stem cell transplantation patients (n = 8). Forty-three biomarkers were investigated, of which 6 (CRP, PCT, IL-8, IL-6, IL-10, and TNFα) were significantly associated with bacterial infection at admission, studied in multiple studies, and provided predictive data. Literature on the prediction of viral and fungal infection was too limited. Eight studies compared C-reactive protein (CRP) and procalcitonin (PCT), with PCT demonstrating superiority in 5. IL-6, IL-8, and IL-10 were compared with CRP in six, four, and one study, respectively, with mixed results on diagnostic superiority. No clear superior biomarker comparing PCT vs. IL-6, IL-8, or IL-10 was identified.DiscussionThere is great heterogeneity in the biomarkers studied and cutoff values and definitions used, thus complicating the analysis. Literature for immunocompromised children with non-malignant disease and for non-bacterial infection is sparse. Literature on novel diagnostics was not available. We illustrated the challenges of diagnosing fever adequately in this study population and the need for improved biomarkers and clinical decision-making tools.

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Section: Resultsmentioning

confidence: 99%

Biomarkers for Diagnosing Febrile Illness in Immunocompromised Children: A Systematic Review of the Literature

2022

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“…Recruitment for the transcriptomic analysis was conducted at two of the eight study sites 8 : Royal Children’s Hospital (RCH), Melbourne, and Queensland Children’s Hospital (QCH), Brisbane. The analysis of plasma abundance of 33 cytokines, CRP and PCT in the same cohort of patients is reported elsewhere 10 …”

Section: Methodsmentioning

confidence: 99%

“…The analysis of plasma abundance of 33 cytokines, CRP and PCT in the same cohort of patients is reported elsewhere. 10 Children with solid-organ cancer or leukaemia on active treatment and who presented to the emergency department with FN were included. Fever was defined as a single temperature ≥ 38°C, and neutropenia was defined as an absolute neutrophil count (ANC) < 1000 mm À3 .…”

Section: Patient Recruitment and Blood Sample Collectionmentioning

confidence: 99%

“…8,9 In the same cohort of patients, we have shown that procalcitonin (PCT) and interleukin (IL)-10 may enhance the accuracy of existing CDRs for the prediction of bacterial infection. 10 In this exploratory study we compared the transcriptional profile of peripheral blood mononuclear cells (PBMCs) from children with cancer and FN with documented infection and unexplained fever. We also investigated how the transcriptomes changed over the 24-h period post admission and initiation of therapy.…”

Section: Introductionmentioning

confidence: 99%

“…The Australian Predicating Infectious ComplicatioNs In Children with Cancer (PICNICC) study was a large multisite, prospective cohort study designed to validate existing paediatric FN clinical decision rules (CDRs) and to identify novel biomarkers and immune profiles that predict severe infection 8,9 . In the same cohort of patients, we have shown that procalcitonin (PCT) and interleukin (IL)‐10 may enhance the accuracy of existing CDRs for the prediction of bacterial infection 10 . In this exploratory study we compared the transcriptional profile of peripheral blood mononuclear cells (PBMCs) from children with cancer and FN with documented infection and unexplained fever.…”

Section: Introductionmentioning

confidence: 99%

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Blood transcriptomics identifies immune signatures indicative of infectious complications in childhood cancer patients with febrile neutropenia

et al. 2022

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Objectives. Febrile neutropenia (FN) is a major cause of treatment disruption and unplanned hospitalization in childhood cancer patients. This study investigated the transcriptome of peripheral blood mononuclear cells (PBMCs) in children with cancer and FN to identify potential predictors of serious infection. Methods. Wholegenome transcriptional profiling was conducted on PBMCs collected during episodes of FN in children with cancer at presentation to the hospital (Day 1; n = 73) and within 8-24 h (Day 2; n = 28) after admission. Differentially expressed genes as well as gene pathways that correlated with clinical outcomes were defined for different infectious outcomes. Results. Global differences in gene expression associated with specific immune responses in children with FN and documented infection, compared to episodes without documented infection, were identified at admission. These differences resolved over the subsequent 8-24 h. Distinct gene signatures specific for bacteraemia were identified both at

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Assessment value of interleukin‐6, procalcitonin, and C‐reactive protein early kinetics for initial antibiotic efficacy in patients with febrile neutropenia: A prospective study

Zheng,

Luo,

et al. 2024

Cancer Medicine

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BackgroundThis study aims to investigate the early kinetics of interleukin 6 (IL‐6), procalcitonin (PCT), and C‐reactive protein (CRP) on initial antibiotic efficacy in hematological disorder patients with febrile neutropenia (FN).MethodsA total of 40 patients with 43 episodes of FN were enrolled and divided into initial antibiotic effective group (IAE group, n = 24) and initial antibiotic ineffective group (IAI group, n = 19). The levels of IL‐6, PCT, and CRP before antibacterial treatment (T0), and 12 h (T1), 24 h (T2), 48 h (T3), and 72 h (T4) post‐antibacterial treatment were determined, respectively. Furthermore, the receiver operating characteristic curve (ROC) analysis was performed to evaluate the clinical value of indicators.ResultsIn IAE group, the IL‐6 levels gradually decreased from T0 to T4, and the CRP levels significantly decreased at 48 to 72 h, whereas both IL‐6 and CRP remained at high levels in the IAI group. The PCT levels in both groups increased at the early stage of anti‐infection (T1–T2) and reached to peak at T1–T2 in effective group. ROC curve analysis identified IL‐6 as a predictive biomarker for initial antibiotic efficacy at 12, 48, and 72 h after treatment, with the AUC of 0.698, 0.744, and 0.821, respectively. In addition, CRP demonstrated predictive ability of initial antibiotics against infection at 24, 48, and 72 h after therapy, with the AUC of 0.724, 0.741, and 0.797, respectively. ROC curve analysis of percentage changes demonstrated that IL‐6 percentage change showed predictive ability of antibiotic efficacy at the early stage, and both the IL‐6 and CRP percentage changes showed the predictive ability of antibiotic efficacy 48 or 72 h after antibiotics therapy.ConclusionThis study confirmed IL‐6 and CRP levels, and the percentage change in IL‐6 as the biomarkers for initial antibiotic efficacy prediction in hematological disorder patients with FN.

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Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia

Cited by 11 publications

References 34 publications

Biomarkers for Diagnosing Febrile Illness in Immunocompromised Children: A Systematic Review of the Literature

Biomarkers for Diagnosing Febrile Illness in Immunocompromised Children: A Systematic Review of the Literature

Blood transcriptomics identifies immune signatures indicative of infectious complications in childhood cancer patients with febrile neutropenia

Assessment value of interleukin‐6, procalcitonin, and C‐reactive protein early kinetics for initial antibiotic efficacy in patients with febrile neutropenia: A prospective study

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