Interleukin-6 versus C-reactive protein as markers for early detection of bacteremia in febrile neutropenia in pediatric population

Introduction: Systemic infection leading to multiorgan failure during neutropenia is one of the leading causes of treatment-related mortality among children receiving chemotherapy. Reliable markers are needed to diagnose or rule out infection, to reduce the empirical use of broad-spectrum antibiotic therapy. Aims and Objectives: The aim is to compare the role of interleukin-6 versus C-reactive protein (CRP) as markers of sepsis in febrile neutropenia in pediatric patients while on chemotherapy for malignancy. Materials and Methods: This was a prospective observational study carried out in the Department of Paediatrics of a tertiary care Hospital in South India. All children with malignancy in the age group from 1 month to 18 years diagnosed to have febrile neutropenia during any phase of chemotherapy were included in the study. Multiple episodes of febrile neutropenia in the same child were analyzed as separate episodes. Results: Thirty-two episodes of febrile neutropenia were analyzed. There were 7 microbiologically documented infections (MDI), 19 clinically documented infections and 6 episodes of fever of unknown origin. Out of the 7 MDI, 5 were Gram-negative sepsis and 2 were Gram-positive sepsis. Gram-negative sepsis had a much higher median IL-6 value (169) than Gram-positive sepsis (17.5) and sterile blood cultures (52). However, median value of CRP was only slightly higher in Gram-positive sepsis (85.5) than in Gram-negative sepsis (60.7) and sterile blood cultures (44.2). Conclusion: In this study, higher IL-6 values predicted Gram-negative sepsis better than CRP.