2323. Procalcitonin for Discerning the Etiology of Fever in Children Receiving Allogeneic Hematopoietic Stem Cell Transplantation
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Stem Cell Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Poster_Fever_PCT_IDWeek2016.pdf (647.6 kB)
  • Background:

    Fever is common in children receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT). Discriminating infection (IF) from non infection-related fever (NIF) is critical for the judicious use of antibiotics in these patients. Our aim was to determine whether procalcitonin (PCT) helps in discriminating IF (overall and gram negative) vs. NIF in children receiving allo-HSCT.

    Methods:

    We performed a retrospective chart review of all children and adolescents (0-18 years) receiving an allo-HSCT between January 1st, 2012 and May 1st, 2016 at Centro Medico Imbanaco, in Cali, Colombia.

    Patients who developed fever between day -5 and engraftment were included. Procalcitonin (PCT) levels were documented for the first febrile episode. Each episode was classified as IF (gram –, gram +, viral or fungal) or NIF (alloreactivity, drug fever or fever without source). A ROC curve was constructed to evaluate test performance.

    Results:

    Eighty-two patients received an allo-HSCT during the study period. 72 of them developed fever, at a median of 0 days post transplant. Their mean age was 9.6 years (standard deviation: 5.0) and 54% were male. 54 patients with fever had at least 1 PCT measured during their febrile episode. (table)

    For gram – vs. NIF, the 1st PCT value had an AUC of 0.7 in its ROC curve (figure 1). At a cutoff of 0.99, the PCT had a sensitivity of 88%, specificity of 56%, + likelihood ratio (LR) of 1.97 and – LR of 0.23.

    Conclusion:

     

    PCT may help discriminating IF from NIF, especially in gram – infections.  As patients are usually neutropenic during this period, discriminating gram – infections from NIF is of particular relevance. This biomarker may be useful in developing strategies to offer a more judicious use of antibiotics to this fragile population.

    Table 1. PCT values in NIF, IF and gram – infections

    Variables

    Median (IQR)

    Non-infection related fever (N=27)

    Infection related fever

    (N=27)

    P value

    PCT* value 1

    0.67 (0.09;3.06)

    1.22 (0.13;4.46)

    0.44

    PCT value 2

    0.52 (0.14;1.11)

    1.85  (0.16;7.51)

    0.34

    Non-infection related fever (N=27)

    Gram – infections

    (N=13)

    PCT value 1

    0.67 (0.09; 3.06)

    2.24(1.15; 10.47)

    0.09

    PCT value 2

    0.52 (0.14; 1.11)

    8.78 (4.66; 71.12)**

    N/A

    * In ng/mL units

    ** Samples obtained in 3 patients (23%)

    Eliana Peña, MD1, Oscar Ramirez-Wurttemberger, MD2, Pio Lopez, MD3, Carlos Andres Portilla, MD2, Isabel Cristina Hurtado, MD4 and Eduardo Lopez-Medina, MD5, (1)Pediatrics, Universidad del Valle, Cali, Colombia, (2)Pediatrics, Centro Medico Imbanaco, Cali, Colombia, (3)Pediatrics, Universidad del Valle & Centro de Estudios en Infectologia Pediatrica, Cali, Colombia, (4)Pediatrics, Centro de Estudios en Infectologia Pediatrica, Cali, Colombia, (5)Pediatrics, Universidad del Valle, Centro de Estudios en Infectologia Pediatrica & Centro Medico Imbanaco, Cali, Colombia

    Disclosures:

    E. Peña, None

    O. Ramirez-Wurttemberger, None

    P. Lopez, None

    C. A. Portilla, None

    I. C. Hurtado, None

    E. Lopez-Medina, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.