Clinicohematological profile of febrile neutropenia in childhood acute leukemia and utility of serum procalcitonin levels in neutropenic patients
Shuvendu Roy, Rajan Kapoor, Ashish Simalti, Pulkit Agarwal
Fever, neutropenia, procalcitonin
Citation Information :
Roy S, Kapoor R, Simalti A, Agarwal P. Clinicohematological profile of febrile neutropenia in childhood acute leukemia and utility of serum procalcitonin levels in neutropenic patients. Indian J Crit Care Med 2018; 22 (5):336-339.
Introduction: This study was planned to explore the clinical and hematological profile of febrile neutropenia (FN) in Indian children with focus on correlation of degree of neutropenia with fever and procalcitonin (PCT) level and the utility of serum PCT levels in cases of FN.
Materials and Methods: Children below 12 years, receiving chemotherapy for hematological malignancy having oral temperature more than 100°F and absolute neutrophil count (ANC) below 500/mm3 were included. The aim of this study was to observe the clinicohematological profile of FN and utility of serum PCT levels in neutropenic patients. PCT was done by two-step two-site electrochemiluminescence immunoassay. Serum PCT values were reported as nanogram/ml.
Results: Four categories were made based on serum PCT levels which had negative correlation with ANC but no correlation with microbiologically detected infections. Discussion: PCT is generally used to support the diagnosis of bacterial infection or sepsis in the emergency department or to monitor the treatment of sepsis with regard to reviewing antimicrobial treatment. The use of PCT has been well established as a marker for infection in adults and in nonneutropenic children, but similar data are lacking in pediatric population, more so in children with FN in Indian contexts. This study aims to fulfill this lacuna.
Conclusion: The higher levels of PCT had a high negative correlation with ANC but low correlation with microbiologically detected infections.
Özdemir N, Tüysüz G, Çelik N, Yantri L, Erginöz E, Apak H, et al. Febrile neutropenia in children with acute lymphoblastic leukemia: Single center experience. Turk Pediatri Ars 2016;51:79-86.
Jin M, Khan AI. Procalcitonin: Uses in the clinical laboratory for the diagnosis of sepsis. Lab Med 2010;41:173-7.
Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in Intensive Care Units (PRORATA trial): A multicentre randomised controlled trial. Lancet 2010;375:463-74.
Sharma A, Lokeshwar N. Febrile neutropenia in haematological malignancies. J Postgrad Med 2005;51 Suppl 1:S42-8.
Santolaya ME, Alvarez AM, Becker A, Cofré J, Enríquez N, O'Ryan M, et al. Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. J Clin Oncol 2001;19:3415-21.
Huges WT, Armstrong D, Bodey GP, Feld R, Mandell GL, Meyers JD, et al. Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever: A statement by the Infectious Diseases Society of America. J Infect Dis 1990;16:381.
Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966;64:328-40.
Rosenberg PS, Alter BP, Bolyard AA, Bonilla MA, Boxer LA, Cham B, et al. The incidence of leukemia and mortality from sepsis in patients with severe congenital neutropenia receiving long-term G-CSF therapy. Blood 2006;107:4628-35.
Ramphal R. Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens. Clin Infect Dis 2004;39 Suppl 1:S25-31.
Kitanovski L, Jazbec J, Hojker S, Gubina M, Derganc M. Diagnostic accuracy of procalcitonin and interleukin-6 values for predicting bacteremia and clinical sepsis in febrile neutropenic children with cancer. Eur J Clin Microbiol Infect Dis 2006;25:413-5.
Fleischhack G, Kambeck I, Cipic D, Hasan C, Bode U. Procalcitonin in paediatric cancer patients: Its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumour necrosis factor receptor II. Br J Haematol 2000;111:1093-102.
Schneider HG, Lam QT. Procalcitonin for the clinical laboratory: A review. Pathology 2007;39:383-90.
Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: Systematic review and meta-analysis. Lancet Infect Dis 2007;7:210-7.
Downes KJ, Zaoutis TE, Shah SS. Guidelines for management of children with fever and neutropenia. J Pediatric Infect Dis Soc 2013;2:281-5.
Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34:730-51.