Abstract P-288: CYTOKINES, PROCALCITONIN AND C-REACTIVE PROTEIN FOR SEPSIS DISCRIMINATION IN CHILDREN WITH CANCER AND NEUTROPENIA ON THE FIRST DAY OF FEVER

Abstract

Aims & Objectives: To evaluate cytokines and procalcitonin as sepsis discriminators on the first day of fever in neutropenic children, and to evaluate possible influence of the filgrastim used in the treatment. Methods We tested 10 cytokines by cytometry: IL-8, IL-6, IL-17, IL-21, IL-10, IL-1β, TNF-α, IL-12/23p40, G-CSF and GM-CSF, in addition to C-reactive protein and procalcitonin, in 35 patients with neutropenia after chemotherapy (median age 5.8 years). Results Thirteen patients (37.1%) developed sepsis within 72 hours after the diagnosis of febrile neutropenia. Among septic patients, 10 had bacteria isolated in cultures. IL-6, IL-8, IL-10 and TNF-α showed significant differences between septic and non-septic patients by the Mann-Whitney test. For sepsis discrimination, IL-8 showed an area under the ROC curve (AUC) of 0.86 (95% CI 0.72–1, P <0.0001). The AUC was 0.87 for IL-6 (95% CI 0.75–0.99, P <0.0001) and 0.89 (95% CI 0.78 to 0.99, P <0.0001) for PCT. The optimal cutoff points were 240, 170 and 190 pg/ml for IL-8, IL-6 and PCT (Youden J). PCR showed no power of discrimination. The best observed performance was the combination of IL-8> 100 and PCT> 100 pg/mL, with sensitivity 0.84, specificity 0.91 and Youden index (Y) 0.76. The combination of IL-6> 50 and PCT> 100 had sensitivity 0.85, specificity 0.82 and Y 0.66. Filgrastimupregulated IL-6 and IL-8, with little impact on performance Conclusions IL-6, IL-8 and PCT on the first day of fever are useful markers to identify neutropenic patients who will develop sepsis within 72 hours