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Serum levels of IL-6, IL-8 and IL-10 at fever onset in neutropenic patients: a rapid test for the prediction of Gram-negative bacteraemia? Results of an EORTC Infectious Disease Group multicentre study

Abstract number: 1733_222

Akan H., Paesmans M., Marchetti O., Kern on behalf of the EORTC Infectious Disease Group W.V.

Objectives: Previous studies have suggested that serum or plasma levels of cytokines such as IL-6 or TNF-alpha may have prognostic value in patients with severe sepsis. These and other cytokines have also been studied in febrile neutropenic patients, but the test characteristics for prediction of outcomes in this setting have been variable. We wondered whether the levels of IL-6, IL-8 or IL-10 in samples obtained at fever onset were helpful in predicting bacteraemia in general or, more specifically, Gram-negative bacteraemia (GNB).

Methods: Blood samples were obtained from 573 patients with fever and neutropenia who were included in a multicentre therapeutic trial of the EORTC (EORTC-IDG Trial 46971). The samples were collected at fever onset, centrifuged within 1 hour, frozen and shipped to a central facility where they were stored at -70°C until testing. The cytokine concentrations were measured in duplicate by an immunoluminiscence assay (Immulite) allowing single serum sample measurements within ~45 min.

Results: Most patients had acute leukaemia. Their median age was 46 years (range, 2–86). Fifteen percent of the patients had GNB (anaerobes excluded), and eight percent died. For all three cytokines, there was a significant correlation between serum concentrations and length of fever. Levels of the three cytokines were higher in patients who failed initial empirical therapy because of clinical deterioration. They were highest in the subgroup of patients with GNB. The areas under the receiver operating characteristic curve (AUROCs) for the prediction of bloodstream infection (any organism) was best for IL-10 (0.73; 95% CI, 0.68–0.78) but the differences between IL-10 and IL-6 or IL-8 AUROCs were small and statistically nonsignificant. Similarly, the AUROC for the prediction of GNB was better for IL-10 (0.82; 95% CI, 0.77–0.87) than for IL-8 (0.75; 95% CI, 0.69–0.81) and IL-6 (0.73; 95% CI, 0.67–0.80). At specificity levels of 95%, sensitivities of the three cytokine assays, however, were <50% for the prediction of bacteraemia or GNB.

Conclusion: We conclude that a single serum sample analysis for measurement of one of these interleukins at the onset of febrile neutropenia currently has limited predictive value.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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