title: Serum Procalcitonin for Predicting Significant Infections and Mortality in Pediatric Oncology.
abstract: OBJECTIVE
  To evaluate the role of serum procalcitonin (PCT) level at admission in predicting significant infections and deaths among children on chemotherapy presenting with fever.
  
  
  METHODS
  Children with clinically significant (CSI) and microbiologically documented (MDI) infections were identified using standard definitions. Association of PCT with CSI, MDI and mortality was analyzed.
  
  
  RESULTS
  We evaluated 821 febrile episodes in 316 children. CSI, MDI and deaths were seen in 40.9%, 20.1% and 2.9%, respectively. PCT levels ranged from 0.05-560ng/mL. Median PCT was higher in episodes with CSI (0.80 vs. 0.28) and MDI (0.71 vs. 0.34) (P<0.001). PCT ≥0.7ng/mL optimally predicted CSI (AUC-0.740) and MDI (AUC-0.636). Relative risk of mortality for PCT ≥5ng/mL was 7.1. PCT ≥0.7ng/mL had poor sensitivity (45-55%) but good specificity and NPV (70-90%). PCT was elevated in nearly half of documented viral and fungal infections.
  
  
  CONCLUSIONS
  PCT predicts significant infections and mortality in pediatric oncology but it has poor sensitivity to guide clinical decisions.
authors.affiliation: Pediatric Hematology Oncology and Bone Marrow Transplantation unit, Sir Ganga Ram Hospital, New Delhi, India. Correspondence to: Dr Anupam Sachdeva, Head of Department, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi - 110 060, India. anupamace@yahoo.co.in.
authors.forename: Vinod
authors.initials: V
authors.lastname: Gunasekaran
authors.forename: Nita
authors.initials: N
authors.lastname: Radhakrishnan
authors.forename: Veronique
authors.initials: V
authors.lastname: Dinand
authors.forename: Anupam
authors.initials: A
authors.lastname: Sachdeva
mesh_terms: D019540:Area Under Curve; D001424:Bacterial Infections; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D002648:Child; D064147:Febrile Neutropenia / Q000097:blood* / Q000150:complications / Q000382:microbiology / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D009181:Mycoses; D009369:Neoplasms / Q000150:complications*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014777:Virus Diseases
chemical_list: D015415:Biomarkers; D002116:Calcitonin