Biomarkers for risk stratification of febrile neutropenia among children with malignancy: A pilot study
Biomarkers for risk stratification of febrile neutropenia among children with malignancy: A pilot study
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DOI：
10.1002/pbc.24158
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发表时间：
2012-08-01
影响因子：
3.2
通讯作者：
Prodhan, Parthak
中科院分区：
文献类型：
--
作者：
Mian, Amir;Becton, David;Prodhan, Parthak
背景：接受骨髓抑制化疗的患者发生发热性中性粒细胞减少症（FN）的风险仍然增加。对于这一异质性人群，基于生物标志物的FN患者风险分层可能是一种有用的临床工具。我们假设FN事件最初表现时的血清生物标志物可以预测随后的临床结果。分析了来自36名非连续受试者的89例FN事件。FN高风险标准包括住院时间延长（=7天）、入住儿科重症监护病房（PICU）或微生物学证实的菌血症。低风险FN患者没有上述症状。分析FN住院前2天测量的生物标志物，并将其与各自的临床结果相关联。结果89例FN事件中，44例（49%）符合预先定义的高风险标准，45例（51%）为低风险。降钙素原水平(>0.11？ng/ml)与FN高危结局相关，敏感性为97%。随着对数尺度增加1，成为高危FN的几率增加2倍。Hs-CRP > 100 ?mg/L预测高危FN的敏感性为88%。hs-CRP的对数标度增加1（10倍），高危FN事件的几率增加约1.8倍。在单因素分析中，IL-6、IL-8和IL-10具有统计学意义，并与高危FN相关。然而，IL-1a、sIL-2Ra、IL-3或TNF-a的差异无统计学意义。结论具有适当临界阈值的生物标志物可能是对FN患儿进行适当风险分层的有用临床工具。儿科血癌2012；59:238245。(c) 2012 Wiley期刊有限公司
Background Patients receiving myelosuppressive chemotherapy remain at increased risk for developing febrile neutropenia (FN). For this heterogeneous population, a biomarker based risk stratification of FN patients may be a useful clinical tool. We hypothesized that serum biomarkers during initial presentation of an FN event could be predictive of subsequent clinical outcome. Procedure Eighty-nine FN events from 36 non-consecutive subjects were analyzed. High-risk FN criteria included prolonged hospitalization (=7 days), admission to pediatric intensive care unit (PICU) or a microbiology confirmed bacteremia. Patients with low risk FN had none of the above. Biomarkers measured during the first 2 days of FN hospitalization were analyzed and correlated with respective clinical outcome. Results Of the 89 FN events, 44 (49%) fulfilled pre-defined high-risk criteria and 45 (51%) were low-risk. Procalcitonin level (>0.11?ng/ml) was found to be associated with the high-risk FN outcome with sensitivity of 97%. With an increase in log scale by 1, the odds of being high-risk FN increased twofold. Hs-CRP >100?mg/L had sensitivity of 88% in predicting high-risk FN. The odds of a high-risk FN event increased by approximately 1.8-fold with an increase in the log scale of hs-CRP by 1 (10-fold). In univariate analysis, IL-6, IL-8, and IL-10 were statistically significant and associated with high-risk FN. However, no statistically significant difference was found for IL-1a, sIL-2Ra, IL-3, or TNF-a. Conclusions Biomarkers with appropriate critical threshold values may be a useful clinical tool for appropriate risk stratification of children with FN. Pediatr Blood Cancer 2012;59:238245. (c) 2012 Wiley Periodicals, Inc.