Diagnostic and Prognostic Performance of Proadrenomedullin Versus Procalcitonin in Children with Cancer and Febrile Neutropenia.

OBJECTIVES

Primary objective was to compare the performance of proadrenomedullin (ProADM) and procalcitonin (PCT) for diagnosing clinically documented infections (CDI)/microbiologically documented infections (MDI)/fever without focus (NF) in children with cancer having febrile neutropenia (FN). The secondary objective was to compare the prognostic utility of PCT and ProADM for identifying adverse clinical outcome.

METHODS

Cancer patients (aged ≤ 18 years) presenting with FN were included; those who had received antibiotics within the last 14 days were excluded. Serum PCT and ProADM were estimated on days 1, 3 and 7 of enrolment. Adverse outcome was defined in terms of clinical non-response and day 30 mortality.

RESULTS

We recruited 345 children. PCT in children with MDI were significantly higher than those with CDI on day 1 (P = 0.031) and day 7 (P < 0.001); PCT ≥ 0.21 ng/mL on day 1 had a 77% sensitivity and 44% specificity for diagnosis of MDI; the area under receiver operating characteristic curve (95 CI%) 0.601 (0.49, 0.71). ProADM did not differentiate between MDI and CDI. PCT and ProADM on day 1 did not predict the need for second line antibiotics. PCT ≥ 0.21 ng/mL on day 1 was predictive of MDI (P = 0.041) and PCT ≥ 1.77 ng/mL on day 7 was an independent predictor of day-30 mortality.

CONCLUSIONS

PCT is effective in differentiating between MDI, CDI, and NF in children with FN, and also predicts the day 30 mortality.