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Meta-Analysis
. 2012 Jan 18:10:6.
doi: 10.1186/1741-7015-10-6.

Systematic review and meta-analysis of the value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancer

Robert S Phillips  1 , Ros Wade, Thomas Lehrnbecher, Lesley A Stewart, Alex J Sutton
Affiliations
Meta-Analysis

Systematic review and meta-analysis of the value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancer

Robert S Phillips et al. BMC Med. .

Abstract

Background: Febrile 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.

Methods: This 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.

Results: We 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.

Conclusions: The 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.

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Figures

Figure 1
Figure 1
Flow diagram of study selection process.
Figure 2
Figure 2
Method 1: bivariate pooled estimates of sensitivity and specificity for CRP, PCT and IL6. The plots indicate individual study estimates of sensitivity and specificity with 95% confidence intervals demonstrated by dashed lines, the solid lines indicate the meta-analysis result.
Figure 3
Figure 3
Method 2: hierarchical summary receiver operator curve plots of CRP for the diagnosis of documented infection. a) Circles weighted according to study precision b) Marker points showing threshold (mg/dl).
Figure 4
Figure 4
Method 3: ROC space plot of CRP for documented infection (all thresholds).
See this image and copyright information in PMC

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