title: Predictive value of interleukin-5 and monocyte chemotactic protein-1 for bacteremia in children with febrile neutropenia.
abstract: A variety of clinical and laboratory parameters have been used to predict bacteremia. We hypothesize that the generation of a cytokine profile could be used to identify patients at higher risk of bacteremia at the time of presentation with febrile neutropenia. We prospectively evaluated children with cancer who presented with an episode of febrile neutropenia. A multiplexed flow cytometric assay was performed which measured 15 cytokines and chemokines obtained before the initiation of antibiotics. Fifty-eight episodes of chemotherapy-induced febrile neutropenia were included in this study during which 4 patients (7%) had bacteremia. An interleukin-5 level of >8 pg/dL had a sensitivity of 67% and a specificity of 96% to predict bacteremia. An monocyte chemotactic protein-1 level >1650 pg/dL had a sensitivity of 80% and a specificity of 82% to predict bacteremia. Erythrocyte sedimentation rate, C-reactive protein, protein C, and other cytokines/chemokines were not predictive of bacteremia. Elevations of interleukin-5 and monocyte chemotactic protein-1 are predictive of bacteremia in children with cancer who have febrile neutropenia. Prospective studies should be undertaken to determine whether these parameters retain predictive value in a larger series of patients and can select children for outpatient management or early discharge.
authors.affiliation: Department of Pediatrics, Divisions of Pediatric Hematology and Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75290-9063, USA. victor.aquino@utsouthwestern.edu
authors.forename: Victor M
authors.initials: VM
authors.lastname: Aquino
authors.forename: Carrye
authors.initials: C
authors.lastname: Cost
authors.forename: Ana
authors.initials: A
authors.lastname: Gomez
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Bowers
authors.forename: Octavio
authors.initials: O
authors.lastname: Ramilo
authors.forename: Naveed
authors.initials: N
authors.lastname: Ahmad
authors.forename: Naomi
authors.initials: N
authors.lastname: Winick
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Leavey
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D016470:Bacteremia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D018932:Chemokine CCL2 / Q000097:blood*; D002648:Child; D005260:Female; D006801:Humans; D015848:Interleukin-5 / Q000097:blood*; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D015848:Interleukin-5