Performance of Interleukin-6 and Interleukin-8 serum levels in pediatric oncology patients with neutropenia and fever for the assessment of low-risk

Miriam Diepold¹ , Peter Noellke² , Ulrich Duffner² , Udo Kontny² and Reinhard Berner³

¹Department of Pediatric Oncology and Hematology, University Hospital of Bern, 3010 Bern, Switzerland

²Department of Pediatric Oncology and Hematology, University Hospital of Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany

³Department of Pediatrics and Adolescent Medicine, University Hospital of Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany

author email corresponding author email

BMC Infectious Diseases 2008, 8:28doi:10.1186/1471-2334-8-28


Published:	6 March 2008

Abstract

Background

Patients with chemotherapy-related neutropenia and fever are usually hospitalized and treated on empirical intravenous broad-spectrum antibiotic regimens. Early diagnosis of sepsis in children with febrile neutropenia remains difficult due to non-specific clinical and laboratory signs of infection. We aimed to analyze whether IL-6 and IL-8 could define a group of patients at low risk of septicemia.

Methods

A prospective study was performed to assess the potential value of IL-6, IL-8 and C-reactive protein serum levels to predict severe bacterial infection or bacteremia in febrile neutropenic children with cancer during chemotherapy. Statistical test used: Friedman test, Wilcoxon-Test, Kruskal-Wallis H test, Mann-Whitney U-Test and Receiver Operating Characteristics.

Results

The analysis of cytokine levels measured at the onset of fever indicated that IL-6 and IL-8 are useful to define a possible group of patients with low risk of sepsis. In predicting bacteremia or severe bacterial infection, IL-6 was the best predictor with the optimum IL-6 cut-off level of 42 pg/ml showing a high sensitivity (90%) and specificity (85%).

Conclusion

These findings may have clinical implications for risk-based antimicrobial treatment strategies.