Author/Editor		Kitanovski, Lidija; Derganc, Meta; Jazbec, Janez; Benedik-Dolničar, Majda; Anžič, Jožica; Gubina, Marija; Hojker, Sergej; Krhin, Blaž
Title		Prokalcitonin in interlevkin-6 v diagnostiki hude okužbe pri otrocih s febrilno nevtropenijo
Translated title		Procalcitonin and interleukin-6 as markers of severe infection in children with febrile neutropenia
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. Suppl 1
Publication year		2004
Volume		str. I-165-72
Language		slo
Abstract		Background. The results of the study conducted to determine whether procalcitonin (PCT) and interleukin-6 (IL-6) are more sensitive and specific markers of severe infection in children with febrile neutropenia (FN) than routinelly used C-reactive protein (CRP) are presented in the article. 68 episodes of FN experienced by 32 patients were divided into three groups according to the site of infection. Group 2: episodes of bacteraemia and/or clinical sepsis (n = 16), group 2: episodes offocal infection (n = 16) and group 3: episodes of fever of unknown origin (FUO) (n = 36). Blood samples for further PCT and IL-6 determination were collected on three consecutive days. CRP concentrations were measured daily in each patient until the resolution of fever. PCT, IL-6 and CRP concentrations were measured on one occassion in each of the 18 afebrile patients with malignant disase forming the reference group. Serum PCT and IL-6 concentrations were measured by immunochemiluminometric and immunoenzymatic assay. Receiver Operating Characteristic (ROC) curves were used to determine optimum sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of the studied parameters. Conclusions. PCT and IL-6 were found to be earlier and more sensitive markers of severe infection in neutropenic patients than CRP. The erliest one was IL-6 followed by PCT and CRP. Sequential determination of PCT up to 72 hours improved its diagnostic value, which was not the case for IL-6.In patients with gramnegative bacteraemias PCT concentracions were 3-5 times higher comparing to grampositive, whereas IL-6 concentrations were comparable in both groups.
Summary		Izhodišča. V prispevku so predstavljeni rezultati raziskave, katere namen je bil preučiti, ali sta serumski koncentraciji prokalcitonina (PCT) in interlevkina-6 (IL-6) pri otrocih s febrilno nevtropenijo (FN) občutljivejša in bolj specifična kazalca hude okužbe kot doslej rutinsko uporabljana serumska koncentracija C-reaktivnega proteina (CRP). V raziskavo smo vključili 32 bolnikov z 68 epizodami FN, ki smo jih glede na mesto okužbe razdelili v tri skupine. Skupina 1: epizode bakteriemije in/ali klinične sepse (n = 16), skupina 2: epizode lokalne okužbe (n = 16) in skupina 3: epizode vročine nejasnega izvora (FUO) (n =36). Serumsko koncentracijo PCT in IL-6 smo določali v vzorcih krvi odvzetih prve tri zaporedne dni obravnave epizode. Serumsko koncentracijo CRP smo določali dnevno vse dni povišane telesne temperature (TT). Pri 28 bolnikih referenčne skupine (bolniki z maligno boleznijo brez povišane TT) smo določili koncentracijo PCT, IL-6 in CRP enkratno. Serumsko koncentracijo PCT smo določali z imunoluminiscenčno metodo, IL-6 pa z encimskoimunsko metodo. Mejne vrednosti, občutljivost, specifičnost, pozitivno in negativno napovedno vrednost ter diagnostično zanesljivost vnetnih kazalcev smo določili s krivuljami specifičnosti in občutljivosti (krivulje ROC). Zaključki. Med preučevanimi kazalci se je kot najzgodnejši kazalec hude okužbe izkazal IL-6, sledil je PCT in CRP. Zgodnja diagnostična zanesljivost obeh kazalcev tako PCT kot lL-6, pri napovedovanju hude okužbe je bila boljša kot zanesljivost CRP. 72-urno sledenje koncentracije PCT, ne pa tudi IL-6, je prispevala k zanesljivejšemu diagnosticiranju hude okužbe. Koncentracije PCT pri bolnikih s po Gramu negativno bakteriemijo so bile za 3- do 5-krat višje kot pri bolnikih s po Gramu pozitivno bakteriemijo, medtem ko se koncentracije IL-6 glede na povzročitelja niso razlikovale.
Descriptors		NEUTROPENIA CALCITONIN INTERLEUKIN-6 C-REACTIVE PROTEIN BACTEREMIA CHILD FEVER OF UNKNOWN ORIGIN SEPSIS NEOPLASMS SENSITIVITY AND SPECIFICITY