Comparison of the diagnostic power of cytokine patterns and procalcitonin for predicting infection among paediatric haematology/oncology patients

Abstract

Objectives: To evaluate the diagnostic power of the cytokine patterns and serum procalcitonin (PCT) level for predicting infection in paediatric haematology-oncology patients.

Methods: Retrospective study including hospitalized children with haematology-oncology disease was conducted and their serum T helper type 1/type 2 cytokines were measured by a flow cytometric method. According to clinical symptoms, imaging and microbiological findings, febrile episodes were divided into five diagnostic groups serving as reference standard; and also grouped according to disease severity. A control group consisted of afebrile children.

Results: A total of 3023 samples (2819 febrile episodes and 204 control samples) derived from 992 children (including 164 afebrile control patients) were obtained. Interleukin-6 (IL-6) and IL-10 levels as well as their positivity rates were significantly higher among children with bacteraemia than for the viral infection and control groups. Among children with bacteraemia, 92.8% (297/320) and 82.2% (263/320) had increased IL-6 and IL-10 levels that exceeded the upper limit of the normal range, respectively. The positivity rates of PCT and C-reactive protein were only 33.8% (108/320) and 73.1% (234/320), respectively, significantly lower than those of IL-6 and IL-10 (p <0.01). Based on the receiver operating characteristic curves, PCT exhibited poorer sensitivity in the diagnosis of severe infection compared with IL-6 and IL-10 (p <0.01). Specificity of IL-6 and IL-10 was significantly higher than that of PCT in the diagnosis of Gram-negative bacteraemia.

Conclusion: Cytokine patterns of IL-6 and IL-10 showed higher diagnostic accuracy than PCT for bacteraemia and severe infections among febrile children with haematology/oncology disease.

Keywords: Children; Cytokine; Haematology/oncology; Infection; Procalcitonin.