• Glenn R Stryjewski, Eric S Nylen, Michael J Bell, Richard H Snider, Kenneth L Becker, Amy Wu, Christopher Lawlor, and Heidi Dalton.
• Department of Pediatrics and Critical Care Medicine, Children's National Medical Center, Washington, DC, USA. glenn.stryjewski@tenethealth.com
• Pediatr Crit Care Me. 2005 Mar 1;6(2):129-35.

ObjectiveChildren with cancer often develop febrile illnesses after cytotoxic chemotherapy. Determining which children have serious bacterial infections in this vulnerable period would be valuable. We evaluated the ability of a rapid and sensitive assay for the concentration of calcitonin precursors (CTpr) as a sensitive diagnostic marker for bacterial sepsis in febrile, neutropenic children and determined the utility of measuring cytokines to improve the predictive value of this approach.DesignProspective cohort study.SettingAcademic children's hospital.PatientsFifty-six children (aged 5 months to 17 yrs) with a known malignancy who presented with fever and neutropenia.InterventionsSerial blood samples were obtained (admission, 24 hrs, and 48 hrs), and concentrations of CTpr, interleukin-6, and interleukin-8 were determined. Demographic and laboratory data from the patients were collected from the medical record.Measurements And Main ResultsSixteen (29%) of the children met the criteria for bacterial sepsis. Plasma levels of CTpr and interleukin-8, but not interleukin-6, were increased at all time points in children with sepsis compared with those without sepsis. CTpr at 24 and 48 hrs after admission were reliable markers for sepsis (area under the curve = 0.92 and 0.908, respectively). Logistic regression using CTpr at 24 hrs in addition to interleukin-8 at 48 hrs produced the best-fit models associated with sepsis. Using cutoff values of CTpr >500 pg/mL and interleukin-8 >20 pg/mL produced a screening test for sepsis with 94% sensitivity and 90% specificity.ConclusionsOur data show the utility of a rapid and sensitive assay for CTpr combined with interleukin-8 as a highly sensitive and specific diagnostic marker of bacterial sepsis in febrile, neutropenic children. The use of these markers as a clinical tool may allow for better prognostication for clinicians and may eventually lead to more targeted therapies for this heterogeneous population.

34 keywords...

hide…