title: Adrenomedullin predicts high risk and culture positivity in children with solid tumors suffering from neutropenic fever.
abstract: OBJECTIVE
  Neutropenic fever is a source of morbidity and mortality in children with cancer. It is not possible to detect the causative agent in cultures in most cases; the research for a marker that can show the severity of the disease is ongoing. We evaluated the role of adrenomedullin (ADM) at predicting prognosis on patients with febrile neutropenia, which has been proven to be a good prognostic marker for diseases with high morbidity and mortality, such as heart failure, ischemic ventricular dysfunction, sepsis, and systemic inflammatory response syndrome.
  
  
  METHODS
  We recorded the 36 febrile episodes of 14 children receiving chemotherapy due to solid tumors. There were 10 events with unknown origin in the low-risk group, while in the high-risk group, there were 17 events with unknown origin, 8 events with microbiological origin and 1 event with clinically proven infection. Cultures were positive only in the high-risk group. However, the changes of ADM levels through time periods (first, second, third, and seventh days) were not significant.
  
  
  RESULTS
  The first-day plasma ADM levels significantly predicted the presence of culture positivity (AUC 0.628, 95% CI 0.40-0.85, p = 0.303) and high-risk patients with neutropenic fever (AUC 0.76, 95% CI 0.56-0.97, p = 0.016).
  
  
  CONCLUSIONS
  Our study showed that increased plasma ADM was correlated with high-risk neutropenic fever and culture positivity. The ADM levels in the high-risk group were clearly high at the diagnosis and continued to the end of the treatment.
authors.affiliation: Department of Pediatric Oncology, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Vural
authors.initials: V
authors.lastname: Kesik
authors.affiliation: Department of Pediatric Oncology, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Erman
authors.initials: E
authors.lastname: Ataş
authors.affiliation: Department of Biochemistry, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Gülcan Kurt
authors.affiliation: Department of Biochemistry, Military Hospital, Şırnak, Turkey.
authors.forename: Fevzi Nuri
authors.initials: FN
authors.lastname: Aydın
authors.affiliation: Department of Pediatric Hematology, Gülhane Military Medical Academy, Ankara, Turkey. Electronic address: oguzhanbabacan@yahoo.com.
authors.forename: Oğuzhan
authors.initials: O
authors.lastname: Babacan
authors.affiliation: Department of Pediatrics, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Gülgün
authors.affiliation: Department of Pediatrics, Military Hospital, Turkey.
authors.forename: Nadir
authors.initials: N
authors.lastname: Korkmazer
mesh_terms: D000293:Adolescent; D053607:Adrenomedullin / Q000097:blood*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D064147:Febrile Neutropenia / Q000097:blood* / Q000188:drug therapy / Q000382:microbiology; D005335:Fever of Unknown Origin / Q000097:blood / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D053607:Adrenomedullin
keywords: Adrenomedullin; Cancer; Children; Neutropenic fever; Prognosis