Comparison of the diagnostic power of cytokine patterns and procalcitonin for predicting infection among paediatric haematology/oncology patients.
OBJECTIVE
To evaluate the diagnostic power of the cytokine patterns and serum procalcitonin (PCT) level for predicting infection in paediatric haematology-oncology patients.


METHODS
Retrospective study including hospitalized children with haematology-oncology disease was conducted and their serum T helper type 1/type 2 cytokines were measured by a flow cytometric method. According to clinical symptoms, imaging and microbiological findings, febrile episodes were divided into five diagnostic groups serving as reference standard; and also grouped according to disease severity. A control group consisted of afebrile children.


RESULTS
A total of 3023 samples (2819 febrile episodes and 204 control samples) derived from 992 children (including 164 afebrile control patients) were obtained. Interleukin-6 (IL-6) and IL-10 levels as well as their positivity rates were significantly higher among children with bacteraemia than for the viral infection and control groups. Among children with bacteraemia, 92.8% (297/320) and 82.2% (263/320) had increased IL-6 and IL-10 levels that exceeded the upper limit of the normal range, respectively. The positivity rates of PCT and C-reactive protein were only 33.8% (108/320) and 73.1% (234/320), respectively, significantly lower than those of IL-6 and IL-10 (p <0.01). Based on the receiver operating characteristic curves, PCT exhibited poorer sensitivity in the diagnosis of severe infection compared with IL-6 and IL-10 (p <0.01). Specificity of IL-6 and IL-10 was significantly higher than that of PCT in the diagnosis of Gram-negative bacteraemia.


CONCLUSIONS
Cytokine patterns of IL-6 and IL-10 showed higher diagnostic accuracy than PCT for bacteraemia and severe infections among febrile children with haematology/oncology disease.
Division of Haematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, China.
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T
Xia
Division of Haematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, China.
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Xu
Division of Haematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, China.
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Zhao
Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, China.
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Luo
Division of Haematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, China. Electronic address: Y_M_TANG@zju.edu.cn.
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Tang
D000293:Adolescent; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D005260:Female; D005334:Fever / Q000097:blood / Q000382:microbiology; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000097:blood / Q000150:complications / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007371:Interferon-gamma / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D007376:Interleukin-2 / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D015415:Biomarkers; D016207:Cytokines; C573415:IFNG protein, human; C508609:IL10 protein, human; C508594:IL2 protein, human; C508598:IL4 protein, human; C508600:IL6 protein, human; D007376:Interleukin-2; D015850:Interleukin-6; D016753:Interleukin-10; D015847:Interleukin-4; D007371:Interferon-gamma; D002116:Calcitonin; D002097:C-Reactive Protein
Children; Cytokine; Haematology/oncology; Infection; Procalcitonin