International Journal of Hematology and Oncology
2023, Vol 33, Num 4 Page(s): 230-238
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Interleukin-8 in Febrile Neutropenic Children with Cancers: Its Diagnostic Value for Bacteremia/ Sepsis is Superior to that of Interleukin-6, Mannose Binding Lectin, Procalcitonin and C-Reactive Protein
Arzu AKCAY1, Leyla AGAOGLU2, Hakan EKMEKCI3, Ozlem Balci EKMEKCI3, Ebru SARIBEYOGLU4, Didem ATAY1, Deniz TUGCU5, Zeynep KARAKAS5, Aysegul UNUVAR5, Sema ANAK6, Gulyuz OZTURK1, Omer DEVECIOGLU7
1Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Department of Pediatric Hematology and Oncology / Bone Marrow Transplantation Unit, Istanbul, TURKEY
2Acibadem International Hospital, Department of Pediatric Hematology and Oncology, Istanbul, TURKEY
3Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul, TURKEY
4Carl-Thiem-Klinikum Cottbus Children’s Hospital, Department of Pediatric Hematology and Oncology, GERMANY
5Istanbul University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Istanbul, TURKEY
6Medipol University Faculty of Medicine, Department of Pediatric Hematology and Oncology / Bone Marrow Transplantation Unit, Istanbul, TURKEY
7Memorial Bahcelievler Hospital, Department of Pediatric Hematology- Oncology / Bone Marrow Transplantation Unit, Istanbul, TURKEY
Keywords: Febrile neutropenia, Bacteremia/sepsis, Inflammatory cytokines, Childhood cancer
The aim of this study was to determine the predictive value of serum interleukin-6 (IL-6), interleukin-8 (IL-8), mannose binding lectin (MBL), procalcitonin (PCT) and C-reactive protein (CRP) levels for bacteremia/sepsis (B/S) at the beginning of a febrile episode in children with chemotherapy-induced febril neutropenia (FN). In a prospective study, 54 febrile neutropenic episodes from 30 pediatric cancer patients were analysed. Samples were obtained in two different clinical periods: afebrile neutropenic (AFN) period after chemotherapy and FN period (on the first day of fever). The highest levels of IL-6, IL-8, MBL and PCT were observed in cases of B/S group. However, only IL-8 levels were significantly higher in patients with B/S than those with clinically or microbiologically documented infection and those with fever of unknown origin (p< 0.05). While sensitivity was high for IL-6 and IL-8, specificity value was found to be quite low. The marker with the highest specificity values was PCT. While positive predictive values of all markers were generally low, their negative predictive values were higher. The high levels of IL-8 are more reliable than the levels of IL-6, MBL, CRP and PCT for prediction of B/S in pediatric cancer patients with FN. With the combined use of inflammatory markers and cytokines, the low-risk group for B/S can be determined more clearly in patients with FN at the beginning of the febrile episode.
Arzu AKCAY1, Leyla AGAOGLU2, Hakan EKMEKCI3, Ozlem Balci EKMEKCI3, Ebru SARIBEYOGLU4, Didem ATAY1, Deniz TUGCU5, Zeynep KARAKAS5, Aysegul UNUVAR5, Sema ANAK6, Gulyuz OZTURK1, Omer DEVECIOGLU7
1Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Department of Pediatric Hematology and Oncology / Bone Marrow Transplantation Unit, Istanbul, TURKEY
2Acibadem International Hospital, Department of Pediatric Hematology and Oncology, Istanbul, TURKEY
3Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul, TURKEY
4Carl-Thiem-Klinikum Cottbus Children’s Hospital, Department of Pediatric Hematology and Oncology, GERMANY
5Istanbul University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Istanbul, TURKEY
6Medipol University Faculty of Medicine, Department of Pediatric Hematology and Oncology / Bone Marrow Transplantation Unit, Istanbul, TURKEY
7Memorial Bahcelievler Hospital, Department of Pediatric Hematology- Oncology / Bone Marrow Transplantation Unit, Istanbul, TURKEY
Keywords: Febrile neutropenia, Bacteremia/sepsis, Inflammatory cytokines, Childhood cancer
The aim of this study was to determine the predictive value of serum interleukin-6 (IL-6), interleukin-8 (IL-8), mannose binding lectin (MBL), procalcitonin (PCT) and C-reactive protein (CRP) levels for bacteremia/sepsis (B/S) at the beginning of a febrile episode in children with chemotherapy-induced febril neutropenia (FN). In a prospective study, 54 febrile neutropenic episodes from 30 pediatric cancer patients were analysed. Samples were obtained in two different clinical periods: afebrile neutropenic (AFN) period after chemotherapy and FN period (on the first day of fever). The highest levels of IL-6, IL-8, MBL and PCT were observed in cases of B/S group. However, only IL-8 levels were significantly higher in patients with B/S than those with clinically or microbiologically documented infection and those with fever of unknown origin (p< 0.05). While sensitivity was high for IL-6 and IL-8, specificity value was found to be quite low. The marker with the highest specificity values was PCT. While positive predictive values of all markers were generally low, their negative predictive values were higher. The high levels of IL-8 are more reliable than the levels of IL-6, MBL, CRP and PCT for prediction of B/S in pediatric cancer patients with FN. With the combined use of inflammatory markers and cytokines, the low-risk group for B/S can be determined more clearly in patients with FN at the beginning of the febrile episode.
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