title: The diagnostic value of CRP, IL-8, PCT, and sTREM-1 in the detection of bacterial infections in pediatric oncology patients with febrile neutropenia.
abstract: 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.
authors.affiliation: 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
authors.forename: Karin G E
authors.initials: KG
authors.lastname: Miedema
authors.forename: Eveline S J M
authors.initials: ES
authors.lastname: de Bont
authors.forename: Rob F M Oude
authors.initials: RF
authors.lastname: Elferink
authors.forename: Michel J
authors.initials: MJ
authors.lastname: van Vliet
authors.forename: Claudi S M Oude
authors.initials: CS
authors.lastname: Nijhuis
authors.forename: Willem A
authors.initials: WA
authors.lastname: Kamps
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
mesh_terms: 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
chemical_list: 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
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