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Biomarkers for risk stratification of febrile neutropenia among children with malignancy: A pilot study
Author(s) -
Mian Amir,
Becton David,
Saylors Robert,
James Laura,
Tang Xinyu,
Bhutta Adnan,
Prodhan Parthak
Publication year - 2012
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24158
Subject(s) - medicine , risk stratification , febrile neutropenia , stratification (seeds) , malignancy , neutropenia , intensive care medicine , oncology , chemotherapy , biology , seed dormancy , botany , germination , dormancy
Background Patients receiving myelosuppressive chemotherapy remain at increased risk for developing febrile neutropenia (FN). For this heterogeneous population, a biomarker based risk stratification of FN patients may be a useful clinical tool. We hypothesized that serum biomarkers during initial presentation of an FN event could be predictive of subsequent clinical outcome. Procedure Eighty‐nine FN events from 36 non‐consecutive subjects were analyzed. “High‐risk” FN criteria included prolonged hospitalization (≥7 days), admission to pediatric intensive care unit (PICU) or a microbiology confirmed bacteremia. Patients with “low risk” FN had none of the above. Biomarkers measured during the first 2 days of FN hospitalization were analyzed and correlated with respective clinical outcome. Results Of the 89 FN events, 44 (49%) fulfilled pre‐defined high‐risk criteria and 45 (51%) were low‐risk. Procalcitonin level (>0.11 ng/ml) was found to be associated with the high‐risk FN outcome with sensitivity of 97%. With an increase in log scale by 1, the odds of being high‐risk FN increased twofold. Hs‐CRP >100 mg/L had sensitivity of 88% in predicting high‐risk FN. The odds of a high‐risk FN event increased by approximately 1.8‐fold with an increase in the log scale of hs‐CRP by 1 (10‐fold). In univariate analysis, IL‐6, IL‐8, and IL‐10 were statistically significant and associated with high‐risk FN. However, no statistically significant difference was found for IL‐1α, sIL‐2Ra, IL‐3, or TNF‐α. Conclusions Biomarkers with appropriate critical threshold values may be a useful clinical tool for appropriate risk stratification of children with FN. Pediatr Blood Cancer 2012;59:238–245. © 2012 Wiley Periodicals, Inc.