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BMC Pediatrics

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Open Access 01-12-2017 | Research article

Prospective cohort study of procalcitonin levels in children with cancer presenting with febrile neutropenia

Authors: Victoria Hemming, Adam D. Jakes, Geoff Shenton, Bob Phillips

Published in: BMC Pediatrics | Issue 1/2017

Abstract

Background

Febrile neutropenia (FNP) causes significant morbidity and mortality in children undergoing treatment for cancer. The development of clinical decision rules to help stratify risks in paediatric FNP patients and the use of inflammatory biomarkers to identify high risk patients is an area of recent research. This study aimed to assess if procalcitonin (PCT) levels could be used to help diagnose or exclude severe infection in children with cancer who present with febrile neutropenia, both as a single measurement and in addition to previously developed clinical decision rules.

Methods

This prospective cohort study of a diagnostic test included patients between birth and 18 years old admitted with febrile neutropenia to the Paediatric Oncology and Haematology Ward in Leeds between 1^st October 2012 and 30^th September 2013. Each admission with FNP was treated as a separate episode. Blood was taken for a procalcitonin level at admission with routine investigations. ‘R’ was used for statistical analysis. Likelihood ratios were calculated and multivariable logistic regression.

Results

Forty-eight episodes from 27 patients were included. PCT >2 ng/dL was strongly associated with increased risk of severe infection (likelihood ratio of 26 [95% CI 3.5, 190]). The data suggests that the clinical decision rules are largely ineffective at risk stratification, frequently over-stating the risk of individual episodes. High procalcitonin levels on admission are correlated with a greatly increased risk of severe infection.

Conclusions

This study does not show a definitive benefit in using PCT in FNP though it supports further research on its use. The benefit of novel biomarkers has not been proven and before introducing new tests for patients it is important their benefit above existing features is proven, particularly due to the increasing importance of health economics.

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Title: Prospective cohort study of procalcitonin levels in children with cancer presenting with febrile neutropenia
Authors: Victoria Hemming
Adam D. Jakes
Geoff Shenton
Bob Phillips
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Pediatrics / Issue 1/2017
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-016-0766-8

At a glance: The STEP trials

Springer Medicine

Prospective cohort study of procalcitonin levels in children with cancer presenting with febrile neutropenia

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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