Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia

Doerflinger, M; Haeusler, GM; Li-Wai-Suen, CSN; Clark, JE; Slavin, M; Babl, FE; Allaway, Z; Mechinaud, F; Smyth, GK; De Abreu Lourenco, R; Phillips, B; Pellegrini, M; Thursky, KA

Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia

Doerflinger, M Haeusler, GM Li-Wai-Suen, CSN Clark, JE Slavin, M Babl, FE Allaway, Z Mechinaud, F Smyth, GK De Abreu Lourenco, R

Phillips, B Pellegrini, M Thursky, KA

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Publisher:: FRONTIERS MEDIA SA
Publication Type:: Journal Article
Citation:: Frontiers in Immunology, 2021, 12, pp. 641879
Issue Date:: 2021-05-20

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Field	Value	Language
dc.contributor.author	Doerflinger, M
dc.contributor.author	Haeusler, GM
dc.contributor.author	Li-Wai-Suen, CSN
dc.contributor.author	Clark, JE
dc.contributor.author	Slavin, M
dc.contributor.author	Babl, FE
dc.contributor.author	Allaway, Z
dc.contributor.author	Mechinaud, F
dc.contributor.author	Smyth, GK
dc.contributor.author	De Abreu Lourenco, R https://orcid.org/0000-0002-5978-8774
dc.contributor.author	Phillips, B
dc.contributor.author	Pellegrini, M
dc.contributor.author	Thursky, KA
dc.date.accessioned	2021-08-10T03:48:44Z
dc.date.available	2021-04-27
dc.date.available	2021-08-10T03:48:44Z
dc.date.issued	2021-05-20
dc.identifier.citation	Frontiers in Immunology, 2021, 12, pp. 641879
dc.identifier.issn	1664-3224
dc.identifier.issn	1664-3224
dc.identifier.uri	http://hdl.handle.net/10453/150084
dc.description.abstract	<h4>Objectives</h4>Febrile neutropenia (FN) causes treatment disruption and unplanned hospitalization in children with cancer. Serum biomarkers are infrequently used to stratify these patients into high or low risk for serious infection. This study investigated plasma abundance of cytokines in children with FN and their ability to predict bacteraemia.<h4>Methods</h4>Thirty-three plasma cytokines, C-reactive protein (CRP) and procalcitonin (PCT) were measured using ELISA assays in samples taken at FN presentation (n = 79) and within 8-24 h (Day 2; n = 31). Optimal thresholds for prediction of bacteraemia were identified and the predictive ability of biomarkers in addition to routinely available clinical variables was assessed.<h4>Results</h4>The median age of included FN episodes was 6.0 years and eight (10%) had a bacteraemia. On presentation, elevated PCT, IL-10 and Mip1-beta were significantly associated with bacteraemia, while CRP, IL-6 and IL-8 were not. The combination of PCT (≥0.425 ng/ml) and IL-10 (≥4.37 pg/ml) had a sensitivity of 100% (95% CI 68.8-100%) and specificity of 89% (95% CI 80.0-95.0%) for prediction of bacteraemia, correctly identifying all eight bacteraemia episodes and classifying 16 FN episodes as high-risk. There was limited additive benefit of incorporating clinical variables to this model. On Day 2, there was an 11-fold increase in PCT in episodes with a bacteraemia which was significantly higher than that observed in the non-bacteraemia episodes.<h4>Conclusion</h4>Elevated PCT and IL-10 accurately identified all bacteraemia episodes in our FN cohort and may enhance the early risk stratification process in this population. Prospective validation and implementation is required to determine the impact on health service utilisation.
dc.format	Electronic-eCollection
dc.language	eng
dc.publisher	FRONTIERS MEDIA SA
dc.relation.ispartof	Frontiers in Immunology
dc.relation.isbasedon	10.3389/fimmu.2021.641879
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	1107 Immunology, 1108 Medical Microbiology
dc.title	Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia
dc.type	Journal Article
utslib.citation.volume	12
utslib.location.activity	Switzerland
utslib.for	1107 Immunology
utslib.for	1108 Medical Microbiology
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
utslib.copyright.status	recently_added	*
dc.date.updated	2021-08-10T03:48:41Z
pubs.publication-status	Published
pubs.volume	12

Abstract:

Objectives

Febrile neutropenia (FN) causes treatment disruption and unplanned hospitalization in children with cancer. Serum biomarkers are infrequently used to stratify these patients into high or low risk for serious infection. This study investigated plasma abundance of cytokines in children with FN and their ability to predict bacteraemia.

Methods

Thirty-three plasma cytokines, C-reactive protein (CRP) and procalcitonin (PCT) were measured using ELISA assays in samples taken at FN presentation (n = 79) and within 8-24 h (Day 2; n = 31). Optimal thresholds for prediction of bacteraemia were identified and the predictive ability of biomarkers in addition to routinely available clinical variables was assessed.

Results

The median age of included FN episodes was 6.0 years and eight (10%) had a bacteraemia. On presentation, elevated PCT, IL-10 and Mip1-beta were significantly associated with bacteraemia, while CRP, IL-6 and IL-8 were not. The combination of PCT (≥0.425 ng/ml) and IL-10 (≥4.37 pg/ml) had a sensitivity of 100% (95% CI 68.8-100%) and specificity of 89% (95% CI 80.0-95.0%) for prediction of bacteraemia, correctly identifying all eight bacteraemia episodes and classifying 16 FN episodes as high-risk. There was limited additive benefit of incorporating clinical variables to this model. On Day 2, there was an 11-fold increase in PCT in episodes with a bacteraemia which was significantly higher than that observed in the non-bacteraemia episodes.

Conclusion

Elevated PCT and IL-10 accurately identified all bacteraemia episodes in our FN cohort and may enhance the early risk stratification process in this population. Prospective validation and implementation is required to determine the impact on health service utilisation.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/150084