Variation of serum C-reactive protein (CRP) over time in pediatric cancer patients with febrile illness and its relevance to identified pathogen

Sklavou, Rigina; Karavanaki, Kyriaki; Critselis, Eleni; Kossiva, Lydia; Giannaki, Maria; Τσολιά, Μαρία; Papadakis, Vagelis G.; Papargyri, Sophia; Vlachou, Antonia; Karantonis, Fotis; Gourgiotis, D; Polychronopoulou, Sophia

doi:10.1016/j.clinbiochem.2012.07.088

Cited by 16 publications

(14 citation statements)

References 22 publications

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“…According Sklavou et al the change rate of CRP over time is offered as a prognostic index of bacterial infection and a marker of the total duration of fever in febrile neutropenic children [5]. However, because of late peak levels of CRP, this marker cannot be use in urgent diagnostics of severe infections.…”

Section: Discussionmentioning

confidence: 99%

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The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients

Plesko¹,

Suvada²,

Makohusová³

et al. 2016

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Bacterial infection is the most common complication in paediatric oncological patients during cancer treatment. A suitable tool for early prediction of unfavourable course of infection is still needed. We performed a prospective longitudinal observational study to evaluate of the role of serum biomarkers (C-reactive protein, procalcitonin, interleukin-6, presepsin) in the early diagnosis of bacteraemia (gram-negative versus gram-positive) in patients with haematological malignancies. We observed 69 febrile episodes in 33 patients (17 male, 16 female; 1.5-18.9 years, mean 7.31 years, median 5 years). Within this sample, there were 22 cases of positive blood cultures, 16 cases of sepsis, 38 cases of fever with no signs or symptoms of sepsis, and two deaths from infectious complications. All markers tested had good negative predictive value (73% -93%). CRP was characterized by good specificity for registration bacteraemia (96%, 95% CI: 85% -99%), but other results were inconclusive. We identified comparably balanced sensitivity (64% -81%) and specificity (61% -88%) for interleukin-6 and procalcitonin, and we proved their quality to predict positive blood culture and clinical signs of sepsis as well. Patients with gram-negative bacteraemia had significantly elevated levels of PCT and IL-6 in comparison with a group of patients with gram-positive bacteraemia (p = 0.04 for PCT and p = 0.005 for IL-6). Presepsin was characterized by poor specificity (27%, 95% CI: 15% -43%) and positive predictive value (24%, 95% CI: 12 -39%) for predicting bacteraemia, and by better sensitivity (84%, 95% CI: 55% -98%) and specificity (58%, 95% CI: 42% -73%) for predicting clinical signs of sepsis. Key words: C-reactive protein, procalcitonin, interleukin-6, presepsin, fever, sepsisBacterial infection is the most common treatment-related complication in patients with haematological malignancies [1]. Documented mortality associated with paediatric febrile neutropenia is 2% [2]. The potential for early diagnosis of bacteraemia through serum biomarkers has been the subject to extensive research [3]. In 2012 Phillips et al published large meta-analysis of 25 studies exploring 14 different biomarkers in 3,585 episodes of febrile neutropenia. CRP, PCT and IL-6 were subject to quantitative meta-analysis. The bivariate estimates of diagnostic precision of these biomarkers and outcomes were done. Data were available for meta-analysis for CRP for microbiologically or clinically documented infection (results: cut off > 50mg/dl, sensitivity 65%, specificity 73%), for PCT assessing microbiologically or clinically documented infection (results: cut off > 0.2 mg/ml, sensitivity 96%, specificity 85%), for IL-6 reporting microbiologically or clinically documented infection (results: cut off > 235 pg/ml, sensitivity 68%, specificity 94%), and gram-negative bacteraemia (results: cut off > 1000 pg/ml, sensitivity 78%, specificity 96%). Huge inconsistencies and heterogeneity in the studies included in this review were the most important limiting factors [...

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Section: Discussionmentioning

confidence: 99%

“…Some studies have found correlation between CRP and duration of fever and clinical severity of febrile neutropenic episodes, but these findings have not been consistently replicated [4][5][6][7]. CRP levels also increase slowly relative to cytokines and PCT [3,4].…”

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confidence: 94%

The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients

Plesko¹,

Suvada²,

Makohusová³

et al. 2016

neo

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“…Central venous catheter (CVC) type is also important: a higher proportion of children with totally implanted devices develop coagulase‐negative staphylococcal (CoNS) infection compared to those with tunnelled CVC (e.g., Hickman or Broviac catheters) . Interest is also increasing in improving risk‐stratification through use of common laboratory parameters, particularly C‐reactive protein (CRP) .…”

Section: Introductionmentioning

confidence: 99%

Invasive bacterial and fungal infections in paediatric patients with cancer: Incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009–2011

Calton

Doaré

Appleby

et al. 2014

Pediatric Blood & Cancer

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“…At 48 hours, WBC, LBP, and CRP levels were re-evaluated. 25 Cultures from biological materials (ie, urine, skin, mucous membranes, sputum, feces, and cyst liquid) were taken according to clinical presentation.…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Lipopolysaccharide-Binding Protein With C-Reactive Protein as Early Inflammation Markers in Pediatric Oncology Patients

Sklavou¹,

Karavanaki²,

Kossiva³

et al. 2015

Infectious Diseases in Clinical Practice

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Variation of serum C-reactive protein (CRP) over time in pediatric cancer patients with febrile illness and its relevance to identified pathogen

Cited by 16 publications

References 22 publications

The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients

The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients

Invasive bacterial and fungal infections in paediatric patients with cancer: Incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009–2011

A Comparison of Lipopolysaccharide-Binding Protein With C-Reactive Protein as Early Inflammation Markers in Pediatric Oncology Patients

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