Early diagnosis of infections in neutropenic patients with haematological malignancies would be helpful in management decisions regarding therapy and hospitalisation. Procalcitonin has proved to be a sensitive inflammatory marker in non-neutropenic patients. The aim of this presentation is to compare procalcitonin with other inflammatory markers in the serum of neutropenic children with haematological malignancies in the early and rapid diagnosis of infection and to assess the predictive value of these mediators in distinguishing between bacterial and non-bacterial infection.
A study included five groups of children with acute lymphoblastic leukaemia undergoing intensive chemotherapy. Group A consisted of 16 neutropenic children with 54 febrile episodes with bacterial infection, group B of 13 neutropenic children with 32 febrile episodes with virus infection, group C of 15 children without neutropenia with 51 febrile episodes with bacterial infection, group D of 11 non-neutropenic children with 35 febrile episodes with virus infection and group E of 49 children without neutropenia and without fever. Blood samples were collected upon admission and then for 7 days on a day-to-day basis. The blood samples were used for culture, serological tests, virus antibodies, leucocyte count and for analysis of procalcitonin, C-reactive protein and inflammatory cytokine levels.
According to our results, procalcitonin is a specific and sensitive marker of microbial infection in patients with neutropenic fever. Serial measurements of procalcitonin levels on a day-to-day basis seem to be helpful, in order to predict severe bacterial infections early, monitor febrile episodes regarding the response to antibiotic therapy and early detect complications in the infectious process.