title: Interleukin-5, interleukin-6, interleukin-8 and tumour necrosis factor-alpha levels obtained within 24-h of admission do not predict high-risk infection in children with febrile neutropenia.
abstract: OBJECTIVE
  Biomarkers that can predict the severity of febrile neutropenia (FN) are potential tools for clinical practice.
  
  
  OBJECTIVE
  The objective of this study is to evaluate the reliability of plasma interleukin (IL) levels as indicators of high-risk FN.
  
  
  METHODS
  Children with haematological malignancies and FN were enrolled prospectively. A blood sample was obtained within 24-h of admission for estimation of IL-5, IL-6, IL-8 and tumour necrosis factor-alpha (TNF-α) level by the enzyme-linked immunosorbent assay. Patients were stratified into three groups. Group I (low-risk): No focus of infection; Group II: Clinical/radiological focus of infection; Group III: Microbiologically proven infection or FN related mortality. Groups II and III were analysed as high-risk. The cytokines were assessed at three different cut-off levels.
  
  
  RESULTS
  A total of 52 episodes of FN in 48 patients were evaluated. The mean age was 6 years (range: 2-13). Primary diagnosis included acute lymphoblastic leukaemia (82%), non-Hodgkin's lymphoma (13%) and acute myeloid leukaemia (5%). Absolute neutrophil count was < 200 cells/μl in half and 200-500 in 23%. Majority were categorised as Group I (69%), followed by Group II (16%) and III (15%). The range of IL-5 was too narrow and similar in the two risk-groups to be of any relevance. The best sensitivity of TNF-α and IL-6 for high-risk group was 78% and 70%, respectively. The highest specificity observed was 35%. The negative predictive value of IL-6, IL-8 and TNF-α exceeded 80%.
  
  
  CONCLUSIONS
  IL-5, IL-6, IL-8 and TNF-α failed as predictors of clinically localised or microbiologically documented infection in children with chemotherapy induced FN. However, IL-6, IL-8 and TNF-α could be useful in excluding the possibility of high-risk infection.
authors.affiliation: Department of Immunopathology, Pediatric Hematology Oncology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: R
authors.initials: R
authors.lastname: Aggarwal
authors.forename: D
authors.initials: D
authors.lastname: Bansal
authors.forename: F
authors.initials: F
authors.lastname: Bansal
authors.forename: N
authors.initials: N
authors.lastname: Nanda
authors.forename: P
authors.initials: P
authors.lastname: Ray
authors.forename: A
authors.initials: A
authors.lastname: Trehan
authors.forename: R K
authors.initials: RK
authors.lastname: Marwaha
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000175:diagnosis* / Q000473:pathology*; D016207:Cytokines / Q000097:blood*; D064147:Febrile Neutropenia / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D016207:Cytokines