Abstract
BackgroundFebrile neutropenia is a frequently occurring and occasionally life-threatening complication of treatment for childhood cancer. Many biomarkers have been proposed as predictors of adverse events. We aimed to undertake a systematic review and meta-analysis to summarize evidence on the discriminatory ability of initial serum biomarkers of febrile neutropenic episodes in children and young people.MethodsThis review was conducted in accordance with the Center for Reviews and Dissemination Methods, using three random effects models to undertake meta-analysis. It was registered with the HTA Registry of systematic reviews, CRD32009100485.ResultsWe found that 25 studies exploring 14 different biomarkers were assessed in 3,585 episodes of febrile neutropenia. C-reactive protein (CRP), pro-calcitonin (PCT), and interleukin-6 (IL6) were subject to quantitative meta-analysis, and revealed huge inconsistencies and heterogeneity in the studies included in this review. Only CRP has been evaluated in assessing its value over the predictive value of simple clinical decision rules.ConclusionsThe limited data available describing the predictive value of biomarkers in the setting of pediatric febrile neutropenia mean firm conclusions cannot yet be reached, although the use of IL6, IL8 and procalcitonin warrant further study.
Highlights
Febrile neutropenia is a frequently occurring and occasionally life-threatening complication of treatment for childhood cancer
It sought studies which evaluated the diagnostic ability of serum biomarkers of inflammation/infection in children or young people aged 0 to 18 years of age, taken at the onset of an episode of febrile neutropenia
This systematic review of the predictive value of serum markers of inflammation and infection in children presenting with febrile neutropenia found 25 studies reporting 14 different markers
Summary
Febrile neutropenia is a frequently occurring and occasionally life-threatening complication of treatment for childhood cancer. The ability of specific serum biomarkers to predict adverse consequences in patients with febrile neutropenia has been explored, for example, C-reactive protein (CRP), pro-calcitonin (PCT), interleukin-6 (IL6) or interleukin-8 (IL8) [9,10,11,12]. These studies have been small in the numbers of patients and episodes and the researchers could not reach definitive conclusions. Drawing these reports together and synthesizing their results should improve our understanding of their clinical usefulness
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