Gomber Sunil, Banerjee Anindya, Dewan Pooja, Das Shukla, Ansari M Ahmad, Rai Gargi, Singh Praveen
Departments of Pediatrics.
Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi.
J Pediatr Hematol Oncol. 2020 Aug;42(6):e416-e422. doi: 10.1097/MPH.0000000000001870.
Febrile neutropenia (FN) is a dreaded complication of cancer chemotherapy. There has been a lot of improvement in supportive care in FN that has drastically reduced the infection-related mortality in these patients. The focus now is on reducing infection-related morbidity, healthcare costs and optimizing the quality of life of the child as well as their family during these episodes. In this study, biomarkers were studied as predictors of outcome so that outcome can be predicted earlier, and treatment modified accordingly.
To measure procalcitonin levels (at baseline and day 3), procalcitonin clearance, neutrophil CD64 expression levels (at baseline) and monocyte HLA-DR expression levels (at baseline), and their correlation with outcome.
Tertiary care hospital.
Cross-sectional observational study.
POPULATION/PARTICIPANTS: Sixty-five episodes of FN in children below 12 years with lymphoreticular malignancies. Children receiving antibacterial and/or antifungal treatment within the last 7 days were excluded from the study.
The subjects recruited into the study had undergone complete clinical and laboratory evaluation as per hospital protocol. Procalcitonin (day 0 and 3), neutrophil CD64 expression, and monocytic HLA-DR expression levels were measured in these patients.
Sixty-five episodes of FN were studied in children with lymphoreticular malignancy. It was found that procalcitonin and HLA-DR are very good markers of outcome, whereas CD64 although a good marker, was inferior to procalcitonin and HLA-DR in predicting outcome. Procalcitonin clearance was found to be superior to single value of procalcitonin. Furthermore, procalcitonin on day 3 was found to be a better predictor of outcome compared with its baseline value. Also, it was found that procalcitonin and HLA-DR had a significant correlation with baseline C-reactive protein levels.
On the basis of the findings of the study we suggest that serial monitoring of procalcitonin levels be used in febrile neutropenic children with cancer. Procalcitonin levels on day 3 alone can be offered in resource poor setting. The role of HLA-DR and CD64 also seems promising and needs to be further explored in larger multicentric studies.
发热性中性粒细胞减少症（FN）是癌症化疗可怕的并发症。FN的支持性护理有了很大改善，这大幅降低了这些患者与感染相关的死亡率。现在的重点是减少与感染相关的发病率、医疗成本，并在这些期间优化儿童及其家庭的生活质量。在本研究中，对生物标志物作为预后预测指标进行了研究，以便能更早预测预后，并相应调整治疗。
测量降钙素原水平（基线和第3天）、降钙素原清除率、中性粒细胞CD64表达水平（基线）和单核细胞HLA-DR表达水平（基线），以及它们与预后的相关性。
三级护理医院。
横断面观察性研究。
研究对象/参与者：65例12岁以下患有淋巴网状恶性肿瘤的儿童FN发作。最近7天内接受过抗菌和/或抗真菌治疗的儿童被排除在研究之外。
按照医院方案对纳入研究的受试者进行了全面的临床和实验室评估。测量了这些患者的降钙素原（第0天和第3天）、中性粒细胞CD64表达和单核细胞HLA-DR表达水平。
对65例患有淋巴网状恶性肿瘤的儿童FN发作进行了研究。发现降钙素原和HLA-DR是非常好的预后标志物，而CD64虽然是一个好的标志物，但在预测预后方面不如降钙素原和HLA-DR。发现降钙素原清除率优于降钙素原单一值。此外，发现第3天的降钙素原比其基线值更能预测预后。还发现降钙素原和HLA-DR与基线C反应蛋白水平有显著相关性。
基于该研究结果，我们建议对患有癌症的发热性中性粒细胞减少症儿童进行降钙素原水平的连续监测。在资源匮乏的环境中，仅第3天的降钙素原水平即可提供参考。HLA-DR和CD64的作用似乎也很有前景，需要在更大规模的多中心研究中进一步探索。
