title: Prospective cohort study of procalcitonin levels in children with cancer presenting with febrile neutropenia.
abstract: Febrile neutropenia (FNP) causes significant morbidity and mortality in children undergoing treatment for cancer. The development of clinical decision rules to help stratify risks in paediatric FNP patients and the use of inflammatory biomarkers to identify high risk patients is an area of recent research. This study aimed to assess if procalcitonin (PCT) levels could be used to help diagnose or exclude severe infection in children with cancer who present with febrile neutropenia, both as a single measurement and in addition to previously developed clinical decision rules.
  
  
  
  This prospective cohort study of a diagnostic test included patients between birth and 18 years old admitted with febrile neutropenia to the Paediatric Oncology and Haematology Ward in Leeds between 1stOctober 2012 and 30thSeptember 2013. Each admission with FNP was treated as a separate episode. Blood was taken for a procalcitonin level at admission with routine investigations. 'R' was used for statistical analysis. Likelihood ratios were calculated and multivariable logistic regression.
  
  
  
  Forty-eight episodes from 27 patients were included. PCT >2 ng/dL was strongly associated with increased risk of severe infection (likelihood ratio of 26 [95% CI 3.5, 190]). The data suggests that the clinical decision rules are largely ineffective at risk stratification, frequently over-stating the risk of individual episodes. High procalcitonin levels on admission are correlated with a greatly increased risk of severe infection.
  
  
  
  This study does not show a definitive benefit in using PCT in FNP though it supports further research on its use. The benefit of novel biomarkers has not been proven and before introducing new tests for patients it is important their benefit above existing features is proven, particularly due to the increasing importance of health economics.
authors.affiliation: Department of Paediatrics, York Teaching Hospitals NHS Foundation Trust, York, UK. victoriahemming@nhs.net.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hemming
authors.affiliation: Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Jakes
authors.affiliation: Department of Paediatric Haematology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Geoff
authors.initials: G
authors.lastname: Shenton
authors.affiliation: Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.|Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Bob
authors.initials: B
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D014408:Biomarkers, Tumor / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D064147:Febrile Neutropenia / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D014408:Biomarkers, Tumor; D002116:Calcitonin
keywords: Cancer; Clinical decision rules; Febrile Neutropenia; Paediatric; Procalcitonin; Risk stratification