A predictor of unfavourable outcome in neutropenic paediatric patients presenting with fever of unknown origin (original) (raw)
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Cancer, 2004
BACKGROUNDCancer patients with fever and neutropenia currently are assessed on clinical grounds only. The current study prospectively evaluated the efficacy of baseline procalcitonin (PCT) in the detection of bacteremia and in the prediction of outcome in patients with solid tumors and febrile neutropenia.Cancer patients with fever and neutropenia currently are assessed on clinical grounds only. The current study prospectively evaluated the efficacy of baseline procalcitonin (PCT) in the detection of bacteremia and in the prediction of outcome in patients with solid tumors and febrile neutropenia.METHODSPCT levels were determined at baseline and every 48 hours in 104 patients undergoing chemotherapy who developed fever (axillary temperature > 38 °C on 2 occasions or > 38.3 °C in a single record) and neutropenia (absolute neutrophil count < 500 cells/μL).PCT levels were determined at baseline and every 48 hours in 104 patients undergoing chemotherapy who developed fever (axillary temperature > 38 °C on 2 occasions or > 38.3 °C in a single record) and neutropenia (absolute neutrophil count < 500 cells/μL).RESULTSThe median baseline PCT values were significantly higher in patients who had microbiologically documented infections (1.24 ng/mL) compared with patients who had clinically documented infections (0.27 ng/mL) or fever of unknown origin (0.21 ng/mL; P < 0.01). Accordingly, a PCT cut-off value of 0.5 ng/mL was reached more frequently in patients who had microbiologically documented infections compared with patients who had clinically documented infections or fever of unknown origin (66.7% vs. 13.4%, respectively; P < 0.001). Furthermore, this threshold also was associated with an increased likelihood of treatment failure (70.0% vs. 14.9%; P < 0.001). All 4 septic patients and all 5 patients who ultimately died presented PCT values 5-fold to 10-fold greater than the median values. Clinical evaluation in combination with baseline PCT assessment appeared to improve clinical risk evaluation alone.The median baseline PCT values were significantly higher in patients who had microbiologically documented infections (1.24 ng/mL) compared with patients who had clinically documented infections (0.27 ng/mL) or fever of unknown origin (0.21 ng/mL; P < 0.01). Accordingly, a PCT cut-off value of 0.5 ng/mL was reached more frequently in patients who had microbiologically documented infections compared with patients who had clinically documented infections or fever of unknown origin (66.7% vs. 13.4%, respectively; P < 0.001). Furthermore, this threshold also was associated with an increased likelihood of treatment failure (70.0% vs. 14.9%; P < 0.001). All 4 septic patients and all 5 patients who ultimately died presented PCT values 5-fold to 10-fold greater than the median values. Clinical evaluation in combination with baseline PCT assessment appeared to improve clinical risk evaluation alone.CONCLUSIONSBaseline PCT levels were higher in patients who had febrile neutropenia with bacteremia compared with patients who had clinical infections or fever of unknown origin. PCT helped to identify patients who had microbiologic infections and patients who were at high risk of treatment failure, and PCT may constitute a complementary tool in the initial assessment of such patients. Cancer 2004. © 2004 American Cancer Society.Baseline PCT levels were higher in patients who had febrile neutropenia with bacteremia compared with patients who had clinical infections or fever of unknown origin. PCT helped to identify patients who had microbiologic infections and patients who were at high risk of treatment failure, and PCT may constitute a complementary tool in the initial assessment of such patients. Cancer 2004. © 2004 American Cancer Society.
Iranian Journal of Pediatric Hematology & Oncology
Background: Febrile neutropenia is still one of the most important complications of treatment in cancer patients. These patients become prone to infection and consequently higher mortality and morbidity. This study aimed to determine the accuracy of serum procalcitonin (PCT) level in the detection of infection in pediatric cancer patients complicated with febrile neutropenia. Materials and Methods: In this cross-sectional study, all pediatric patients affected by cancer and febrile neutropenia following chemotherapy (n=107) were investigated from August 2014 to August 2015. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum levels of PCT, as well as blood and urine culture, were evaluated in all patients. Results: The mean age of the patients was 78 ± 55 months (3 - 214 months), and in terms of gender, 53 patients (49.5%) were male. Overall, 25 patients (23.4%) and 13 patients (12%) showed positive blood and urine culture, respectively. The area under the curv...
International Journal of Advances in Medicine, 2016
Distinguishing infectious from non-infectious causes of fever is challenging. Besides infectious causes such as bacterial, viral, fungal, parasitic, mycobacterial and rickettsial infections, fever can also be caused by noninfectious causes such as autoimmune diseases, malignancy, drugs, venous thromboembolism, transplant rejection, gout, myocardial and cerebral infarction, etc. 1 Traditional markers of systemic inflammation, such as CRP, erythrocyte sedimentation rate (ESR) and total leucocyte count (TLC), have proven to be of limited utility due to their poor sensitivity and specificity for bacterial infection. 1 Blood culture, which is the gold standard for diagnosing bacterial infection has some drawbacks in the form of a long turnaround time, the inability to provide specific information on host response and the inability to distinguish between bacterial colonisation and infection. 2 Early diagnosis and prompt installation of specific therapies is associated with an improved outcome in patients with sepsis. Lack of early, reliable markers of infection may be responsible for ABSTRACT Background: Distinguishing bacterial fever from other fevers is important for early treatment and the judicious use of antibiotics. This study aimed to evaluate the levels of procalcitonin (PCT) in febrile adults and compare it with C reactive protein (CRP) and total leukocyte count (TLC). Methods: 70 patients were classified clinically according to severity of infection into mild (Group A 30), moderate (Group B 23) and severe (Group C 17). 30 healthy controls were taken (Group D). After a detailed clinical history, their blood collected aseptically was sent for complete hemogram, culture, biochemistry, PCT and CRP. PCT was measured by immunochromatographic method (Result Range: <0.5, 2, >2, >10ng/ml). CRP was measured by immunoturbidometry. Chisquare, ANOVA, Pearson's Correlation were used. Results: PCT was significantly elevated with higher degrees of infection (p value < 0.001). Sensitivity and specificity of PCT in Group 2 and 3 were both 100%. Group 1 had no rise in PCT proving that it is neither specific nor sensitive for mild infection. Mean CRP was significantly increased (p value <0.001) with severity of infection; sensitivity and specificity being 97.14% and 80%. TLC increased significantly (p value <0.001) with the severity of infection. However, it did not rise above the cut off, for mild infection. Conclusions: PCT was highly sensitive and specific for moderate to severe infection and also determined prognosis. It could not identify mild local infection. CRP was sensitive for any grade of infection but not specific for bacterial fever. TLC was specific for moderate to severe infection though less sensitive.
American Journal of Hematology, 2010
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Journal of Pediatric Hematology/Oncology, 2007
In clinical practice, when neutropenic-fever patients present with no microbiologically and clinically defined infection, the risk of underestimating an occult infection is of major concern, the clinicians have to make a decision on when to modify antibiotic therapy. Hence, a reliable, specific, and sensitive marker, which is regulated independently from the leukocyte count and the underlying disease, is needed for the early diagnosis of infections in cases of neutropenic fever. We have evaluated the diagnostic and follow-up value of procalcitonin (PCT) compared with C-reactive protein (CRP) and erythrocyte sedimentation rate in documenting the infection in neutropenic-fever patients undergoing intensive chemotherapy, as evidenced by the durational change in these parameters in the presence of defined infection. Forty-nine patients, who had 60 febrile episodes, and who were hospitalized in the Hacettepe University Ihsan Dog˘ramacı Children's Hospital between January 1, 2004 and January 1, 2005 were included in this prospective study. All patients had been diagnosed with neutropenic fever after intensive chemotherapy. In our study, PCT and CRP levels were significantly higher in neutropenicfever patients (group I and group II separately) than in control patients (P<0.001) throughout the study period; but erythrocyte sedimentation rate levels did not show any significant difference (P>0.05). In sequential analyses of patients without documented infections, the median of PCT concentrations shows a tendency to fall after the 8th hour of onset of fever, whereas in patients with documented infections PCT concentrations fell after the 48th hour. In conclusion, our study suggests that PCT, when measured periodically, is a more useful diagnostic inflammation parameter in pediatric neutropenic-fever patients than CRP, both in estimating the severity of the infection and, the duration and origin of the fever. Hence, PCT might be helpful when deciding on initial therapy modification.
Journal of clinical case reports, 2016
Background: Infections are major cause of morbidity and mortality in children receiving cancer chemotherapy particularly when they are neutropenic, mainly due to immune deficiency. Between 48-60% neutropenic patients with fever have an underlying infection which can often be life threatening. Before putting the child on empiric antimicrobial regimes for FN, it is essential to know the spectrum of locally prevalent pathogens and their susceptibility patterns. Often these children don't manifest fever even in presence of infection and fever may be present in neutropenic patients receiving chemotherapy even in the absence of infection. Present diagnostic tools available for diagnoses in FN are often not so robust and do not differentiate between various classes of organisms causing these infections. Procedure: Blood culture is time consuming and negative blood culture does not exclude bacteremia, which leads to the empirical use of broad-spectrum antibiotic treatment in pediatric patients with neutropenia, even where signs of infection are absent. We propose to evaluate the role of PCT, as a sensitive marker to evaluate pediatric oncology patients presenting with FN. Results: Blood-culture was positive in 18.05% of the patients, with majority of patients having gram-negative bacterial infections. On comparison with the focus of infection, high PCT and CRP values were obtained in patients with pulmonary infection than in extra-pulmonary infections. In our study the sensitivity of PCT was high upto 73.3% at a cutoff of ≥0.25 ng/ml for ruling out bacteremia, when compared to blood culture and CRP in our patients. Conclusion: The PCT value is certainly helpful in guiding the physicians in clinical decisions and thus the better approach towards the management of pediatrics oncology patients with FN.
Infection & Chemotherapy, 2019
Background: Procalcitonin (PCT) is a diagnostic biomarker for bacterial infections in critically-ill patients. However, the cutoff value of PCT for the diagnosis of bacterial infections is unclear and unreliable. This study aimed to determine the optimal cutoff value of PCT for the diagnosis of bacterial infections in critically-ill patients. Materials and Methods: We conducted a retrospective study involving 311 adult patients who had been admitted to the medical or surgical intensive care unit for more than 24 hours from 2013 to 2015. At least one blood test for PCT level was performed for all patients within the first 24 hours of suspecting an infection. Results: One hundred and fifty-seven patients had bacterial infections, while 154 did not. Patients with bacterial infections had a significantly higher median PCT level than those without bacterial infections (1.90 ng/mL vs. 0.16 ng/mL, P <0.001). The area under the receiver operating characteristic curve of PCT for discriminating between bacterial and nonbacterial infections was 0.874 (95% confidence interval: 0.834, 0.914; P <0.001). The optimal cutoff value of PCT for differentiating between fevers due to bacterial infections from those due to non-bacterial infections was 0.5 ng/mL, with a sensitivity of 84.7%, specificity of 79.9%, positive predictive value of 81.1%, and negative predictive value of 83.7%. Conclusion: PCT was found to be an accurate biomarker for the diagnosis of bacterial infections among patients admitted to medical and surgical intensive care units. The optimal cutoff value of PCT for the diagnosis of bacterial infections was 0.5 ng/mL.