Assessment of procalcitonin as diagnostic marker in children with neutropenic fever

Abstract

Objective: The aim of this study is to predict the usefulness of procalcitonin (PCT) for diagnosis of systemic and bacterial infections in children with neutropenic fever.

Material and method: In this study 46 neutropenic fever attacks of the 32 cancer patients were evaluated. Newly diagnosed 35 cancer patients were selected as control. Serum levels of PCT and CRP (C reactive protein) were determined on the first and third days of fever and at the end of the antimicrobial therapy in study group. Neutropenic fever episodes were classified as fever unknown origin (FUO), microbiologically and clinically documented infection (MDI, CDI). MDI were further subdivided into two groups as systemic and localized infection.

Results: Serum levels of PCT were highest on the first day of neutropenic fever in MDI group. The levels of PCT were higher in systemic infections than localized ones. There was no difference for the serum levels of CRP in FUO, CDI and MDI or systemic and localized infections. The PCT levels rapidly decreased to the normal range by resolution of fever with successful antimicrobial therapy.

Conclusion: We conclude that serial measurement of serum PCT levels is more sensitive and specific than that of CRP for diagnosis and sequential assessment of febrile neutropenic episodes.

Keywords

• procalcitonin; neutropenic fever; children

Prokalsitonin’in çocukluk çağı nötropenik ateşinde tanısal değeri

Öz

Amaç: Bu çalışmanın amacı çocukluk çağı nötropenik ateşinde prokalsitonin (PCT)’in bakteriyel ve sistemik enfesiyonların tanısı ve izlenmesindeki yararlılığının tespit edilmesidir.

Gereç ve Yöntem: Bu çalışmada 32 kanser tanısı ile izlenen hastanın 46 nötropenik atağı değerlendirilmiştir. 35 yeni kanser tanısı alan olgu da kontrol grubu olarak seçilmiştir. Çalışma grubundaki olguların ateşin 1. ve 3. günü ile antibiyotik tedavisinin sonunda; kontrol grubundaki olguların ise kanser tanısı aldıkları gün serum PCT ve CRP (C- reaktif protein) değerleri ölçülmüştür. Nötropenik ateş atakları nedeni bilinmeyen ateş, mikrobiyolojik olarak kanıtlanmış enfeksiyon ve klinik olarak kanıtlanmış enfeksiyon olarak üç gruba ayrılmıştır. Mikrobiyolojik olarak kanıtlanmış infeksiyon grubu da lokalize ve sistemik enfeksiyon olarak iki alt gruba ayrılmıştır.

Bulgular: Mikrobiyolojik olarak kanıtlanmış enfeksiyon grubunda en yüksek serum PCT düzeyi enfeksiyonun ilk gününde tespit edilmiştir. Serum PCT düzeyleri sistemik enfeksiyonu olan olgularda lokalize enfeksiyonu olan olgulara göre daha yüksek tespit edilmiştir. Nedeni bilinmeyen ateş, klinik ve mikrobiyolojik olarak tanımlamış enfeksiyon, lokalize enfeksiyon ve sistemik enfeksiyon gruplarında serum CRP düzeyleri açısından farklılık saptanmamıştır.

Sonuç: Bu sonuçlar bize serum PCT düzeyinin bakteriyel ve sistemik infeksiyonun tanısı ve izleminde CRP’ye göre daha özgül ve duyarlı bir serum belirteci olduğunu düşündürmüştür. 

Anahtar Kelimeler

• Prokalsitonin, Nötropenik ateş, Çocuk

Kaynakça

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