The diagnostic value of CRP, IL-8, PCT, and sTREM-1 in the detection of bacterial infections in pediatric oncology patients with febrile neutropenia.
OBJECTIVE
In this study, we evaluated C-reactive protein (CRP), interleukin (IL)-8, procalcitonin (PCT), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as predictors for bacterial infection in febrile neutropenia, plus their usefulness in febrile neutropenia during chemotherapy-induced gastrointestinal mucositis.


METHODS
Plasma was obtained from pediatric oncology patients at presentation with febrile neutropenia (n = 43) and 24-48 h later (n = 17). The patients were classified as having or not having a bacterial infection. Plasma was also obtained of patients in the absence and in the presence of mucositis (n = 26).


RESULTS
At presentation with febrile neutropenia, median IL-8 and PCT levels were significantly increased in patients with a bacterial infection, in contrast to CRP and sTREM-1. IL-8 was the most sensitive marker for the early detection of bacterial infection, in combination with clinical parameters or PCT the sensitivity reached 100%. After 24-48 h, only PCT was significantly elevated during bacterial infection. IL-8 levels were significantly increased during mucositis. Mucositis did not cause considerable changes in PCT levels.


CONCLUSIONS
IL-8 is the most useful marker for the early detection of bacterial infections, compared with CRP, PCT, and sTREM-1. IL-8 in combination with clinical parameters or PCT might be even more useful. Gastrointestinal mucositis alone does not affect PCT levels, in contrast to IL-8 levels, and therefore, PCT might be more useful for the detection of bacterial infections during mucositis than IL-8.
Miedema
Karin G E
KG
Division of Pediatric Oncology and Pediatric Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. k.g.e.miedema@bkk.umcg.nl
de Bont
Eveline S J M
ES
Elferink
Rob F M Oude
RF
van Vliet
Michel J
MJ
Nijhuis
Claudi S M Oude
CS
Kamps
Willem A
WA
Tissing
Wim J E
WJ
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000473:pathology; D006801:Humans; D016209:Interleukin-8 / Q000097:blood*; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D052016:Mucositis / Q000139:chemically induced; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D011971:Receptors, Immunologic / Q000097:blood; D012680:Sensitivity and Specificity; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
D000970:Antineoplastic Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D016209:Interleukin-8; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
Lancet. 1993 Feb 27;341(8844):515-8
8094770
Anaesth Intensive Care. 2008 Sep;36(5):654-8
18853582
Bone Marrow Transplant. 2005 Oct;36(8):703-7
16062174
Clin Infect Dis. 2007 Nov 15;45(10):1296-304
17968824
J Clin Oncol. 2000 Mar;18(5):1012-9
10694551
Cancer Invest. 2006 Aug-Sep;24(5):479-83
16939955
Pediatr Crit Care Med. 2005 Mar;6(2):129-35
15730597
J Infect Dis. 1995 Aug;172(2):610
7622920
Crit Care. 2009;13(3):R83
19493352
J Clin Endocrinol Metab. 1994 Dec;79(6):1605-8
7989463
Crit Rev Oncol Hematol. 2009 Oct;72(1):45-55
19195908
Clin Infect Dis. 2002 Mar 15;34(6):730-51
11850858
Ann Intern Med. 1966 Feb;64(2):328-40
5216294
J Pediatr Hematol Oncol. 2007 Feb;29(2):107-11
17279007
Eur J Anaesthesiol. 2009 Jun;26(6):504-7
19307971
Pediatr Blood Cancer. 2009 Dec 15;53(7):1188-94
19688831
J Immunol. 2000 May 15;164(10):4991-5
10799849
Inflamm Res. 2010 May;59(5):339-47
19806318
Intensive Care Med. 2005 Apr;31(4):594-7
15754199
Clin Infect Dis. 1999 Aug;29(2):414-9
10476751
J Clin Oncol. 2010 Apr 20;28(12):2008-14
20231680
Int J Radiat Oncol Biol Phys. 2009 Oct 1;75(2):393-8
19362778
J Clin Oncol. 2001 Jul 15;19(14):3415-21
11454890
Infection. 1996 Nov-Dec;24(6):434-6
9007590
Br J Haematol. 1997 Dec;99(3):580-8
9401070
Br J Haematol. 2000 Dec;111(4):1093-102
11167745
Pediatr Infect Dis J. 1992 Sep;11(9):708-12
1448309
Leuk Lymphoma. 2008 Sep;49(9):1752-61
18661397
Med Pediatr Oncol. 2003 Nov;41(5):436-43
14515382
J Clin Oncol. 2005 Oct 20;23(30):7437-44
16234511
Br J Haematol. 1999 Nov;107(2):375-80
10583227
Clin Infect Dis. 2001 Mar 1;32(5):832-5
11229856
J Infect Dis. 1992 May;165(5):886-90
1569338
Ann Oncol. 2010 Aug;21(8):1706-1711
20089560
Am J Respir Crit Care Med. 2008 Mar 1;177(5):498-505
18096708
Int J Hematol. 2000 Dec;72(4):391-8
11197203
BMC Pediatr. 2005 May 18;5(1):10
15904510
Surg Infect (Larchmt). 2009 Oct;10(5):435-9
19792836