Diagnostic relevance of interleukin-6 and tumour necrosis factor alpha in discriminating high-risk and low-risk groups in febrile

Abstract number: 1733_221

Parsa M., Najjar najafi S., Jonaidi jafari N., Mohraz M., Ghavam zadeh A., Bahar B., Izadi M., Radfar H., Ghofrani H.

Objectives: Early diagnosis of serious infection in an important issue in feverish patients with neutropenia. Identifying serum markers of immunologic response may be useful for distinguish patients with high risk or low risk. Serum IL-6 and TNF-alpha have shown to increase in response to sepsis and infection in non-neutropenic patients. The present study was designed to determine diagnostic value of IL-6 and TNF-alpha in patients with fever and neutropenia.

Methods: This is a prospective study of 133 patients admitted to two university hospital in Tehran, Iran with fever and neutropenia. Patients were divided two groups as low risk and high-risk groups. Cytokines level compared with Mann-Whitney test in study groups of patients and ROC curves used to determine best cut-off points level for cytokines discriminating risk groups.

Results: Mean age of patients was 26.8±2.5 years and 7.5% of patients allocated in low risk group. The mean IL-6 and TNF-alpha serum level below 17 pg/mL was defined as best cut-off point determining low risk group patients with sensitivity and specificity of 70% and 67.5% respectively. However, we cannot define a statistically significant cut-off point for TNF-alpha to use as a diagnostic test.13.5% of patients of our study have positive blood cultures (6% Gram-negative, 6% Gram-positive, 1.5% fungi), but no statistical difference had found in serum IL-6 and TNF-alpha levels in blood culture groups.

Conclusion: Despite our findings about IL-6 diagnostic value in neutropenic patients with fever and its advantages in discriminating risk groups of patients it seem necessary to design a randomised controlled trial before use of this marker.