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Volume 9
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10.3390/children9060833
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Article

A Dynamic Approach for Early Risk Prediction of Gram-Negative Bloodstream Infection and Systemic Inflammatory Response Syndrome in Febrile Pediatric Hemato-Oncology Patients

by
José Antonio Villegas Rubio
1,*,
Pilar Palomo Moraleda
2,
Ana De Lucio Delgado
1,
Gonzalo Solís Sánchez
3,4,5,
Belén Prieto García
6 and
Corsino Rey Galán
4,5,7
1
Pediatric Oncology Unit, Pediatrics Department, Central University Hospital of Asturias, Avda, Roma s/n, 330011 Oviedo, Spain
2
Pediatric Hematology Unit, Hematology Department, Central University Hospital of Asturias, 330011 Oviedo, Spain
3
Neonatology Unit, Pediatrics Department, Central University Hospital of Asturias, 330011 Oviedo, Spain
4
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, 28028 Madrid, Spain
5
Instituto de Investigación Sanitaria del Principado de Asturias, 330011 Oviedo, Spain
6
Clinical Biochemistry, Laboratory of Medicine, Central University Hospital of Asturias, 330011 Oviedo, Spain
7
Intensive Care Unit, Pediatrics Department, Central University Hospital of Asturias, 330011 Oviedo, Spain
*
Author to whom correspondence should be addressed.
Children 2022, 9(6), 833; https://doi.org/10.3390/children9060833
Submission received: 2 May 2022 / Revised: 31 May 2022 / Accepted: 1 June 2022 / Published: 3 June 2022
(This article belongs to the Section Pediatric Hematology & Oncology)
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Abstract

Background: The aim of this study was to evaluate the usefulness of C-Reactive Protein (CRP), Procalcitonin (PCT), and Interleukine 6 (IL6) biomarkers in predicting the existence of high-risk episodes (HRE) during the first 24 h of fever in pediatric cancer patients. HRE were defined as the presence of Gram-negative bloodstream infections or Systemic Inflammatory Response Syndrome. Methods: The study included 103 consecutive fever episodes in 44 hemato-oncological pediatric patients, from whom samples for biomarkers were taken upon initial evaluation (CRP-1, PCT-1 and IL6-1) and then between 12 and 24 h afterward (CRP-2, PCT-2 and IL6-2). Results: An IL6-1 value higher than 164 pg/mL showed an area under the curve (AUC) of 0.890 (0.791–0.989) and OR of 48.68 (7.92–951.42, p < 0.001) to detect HRE in multivariate analysis. A PCT-1 higher than 0.32 ng/mL showed an AUC of 0.805 (0.700–0.910) and OR of 4.55 (0.90–27.84, p = 0.076). A PCT-2 higher than 0.94 ng/mL showed an AUC of 0.836 (0.725–0.947) and OR of 13.01 (1.82–149.13, p = 0.018), and an increase in CRP between the first and second sample (CRP-2vs1) higher than 291% also showed an AUC of 0.785 (0.655–0.915) and OR of 31.09 (4.87–355.33, p = 0.001). Conclusions: IL6-1, PCT-2, and CRP-2vs1 showed a strong and independent correlation with HREs in pediatric cancer patients. CRP variations over the first 24 h provide an improvement in predictive models that are especially useful if IL-6 and PCT are not available.
Keywords: infection; biomarker; pediatric; oncology; hematology infection; biomarker; pediatric; oncology; hematology

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MDPI and ACS Style

Villegas Rubio, J.A.; Palomo Moraleda, P.; De Lucio Delgado, A.; Solís Sánchez, G.; Prieto García, B.; Rey Galán, C. A Dynamic Approach for Early Risk Prediction of Gram-Negative Bloodstream Infection and Systemic Inflammatory Response Syndrome in Febrile Pediatric Hemato-Oncology Patients. Children 2022, 9, 833. https://doi.org/10.3390/children9060833

AMA Style

Villegas Rubio JA, Palomo Moraleda P, De Lucio Delgado A, Solís Sánchez G, Prieto García B, Rey Galán C. A Dynamic Approach for Early Risk Prediction of Gram-Negative Bloodstream Infection and Systemic Inflammatory Response Syndrome in Febrile Pediatric Hemato-Oncology Patients. Children. 2022; 9(6):833. https://doi.org/10.3390/children9060833

Chicago/Turabian Style

Villegas Rubio, José Antonio, Pilar Palomo Moraleda, Ana De Lucio Delgado, Gonzalo Solís Sánchez, Belén Prieto García, and Corsino Rey Galán. 2022. "A Dynamic Approach for Early Risk Prediction of Gram-Negative Bloodstream Infection and Systemic Inflammatory Response Syndrome in Febrile Pediatric Hemato-Oncology Patients" Children 9, no. 6: 833. https://doi.org/10.3390/children9060833

APA Style

Villegas Rubio, J. A., Palomo Moraleda, P., De Lucio Delgado, A., Solís Sánchez, G., Prieto García, B., & Rey Galán, C. (2022). A Dynamic Approach for Early Risk Prediction of Gram-Negative Bloodstream Infection and Systemic Inflammatory Response Syndrome in Febrile Pediatric Hemato-Oncology Patients. Children, 9(6), 833. https://doi.org/10.3390/children9060833

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