Vinod Gunasekaran1, Nita Radhakrishnan, Veronique Dinand, Anupam Sachdeva. 1. Pediatric Hematology Oncology and Bone Marrow Transplantation unit, Sir Ganga Ram Hospital, New Delhi, India. Correspondence to: Dr Anupam Sachdeva, Head of Department, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi - 110 060, India. anupamace@yahoo.co.in.
Abstract
OBJECTIVE: To evaluate the role of serum procalcitonin (PCT) level at admission in predicting significant infections and deaths among children on chemotherapy presenting with fever. METHODS: Children with clinically significant (CSI) and microbiologically documented (MDI) infections were identified using standard definitions. Association of PCT with CSI, MDI and mortality was analyzed. RESULTS: We evaluated 821 febrile episodes in 316 children. CSI, MDI and deaths were seen in 40.9%, 20.1% and 2.9%, respectively. PCT levels ranged from 0.05-560ng/mL. Median PCT was higher in episodes with CSI (0.80 vs. 0.28) and MDI (0.71 vs. 0.34) (P<0.001). PCT ≥0.7ng/mL optimally predicted CSI (AUC-0.740) and MDI (AUC-0.636). Relative risk of mortality for PCT ≥5ng/mL was 7.1. PCT ≥0.7ng/mL had poor sensitivity (45-55%) but good specificity and NPV (70-90%). PCT was elevated in nearly half of documented viral and fungal infections. CONCLUSION: PCT predicts significant infections and mortality in pediatric oncology but it has poor sensitivity to guide clinical decisions.
OBJECTIVE: To evaluate the role of serum procalcitonin (PCT) level at admission in predicting significant infections and deaths among children on chemotherapy presenting with fever. METHODS:Children with clinically significant (CSI) and microbiologically documented (MDI) infections were identified using standard definitions. Association of PCT with CSI, MDI and mortality was analyzed. RESULTS: We evaluated 821 febrile episodes in 316 children. CSI, MDI and deaths were seen in 40.9%, 20.1% and 2.9%, respectively. PCT levels ranged from 0.05-560ng/mL. Median PCT was higher in episodes with CSI (0.80 vs. 0.28) and MDI (0.71 vs. 0.34) (P<0.001). PCT ≥0.7ng/mL optimally predicted CSI (AUC-0.740) and MDI (AUC-0.636). Relative risk of mortality for PCT ≥5ng/mL was 7.1. PCT ≥0.7ng/mL had poor sensitivity (45-55%) but good specificity and NPV (70-90%). PCT was elevated in nearly half of documented viral and fungal infections. CONCLUSION: PCT predicts significant infections and mortality in pediatric oncology but it has poor sensitivity to guide clinical decisions.
Authors: Karin Melanie Cabanillas Stanchi; Manon Queudeville; Carmen Malaval; Judith Feucht; Patrick Schlegel; Markus Dobratz; Christian Seitz; Ingo Müller; Peter Lang; Rupert Handgretinger; Michaela Döring Journal: J Cancer Res Clin Oncol Date: 2019-08-24 Impact factor: 4.322