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Procalcitonina como biomarcador diagnóstico de sepsis en el niño con cáncer, neutropenia y fiebre: revisión de la literatura Translated title: Procalcitonin as a diagnostic biomarker of sepsis in children with cancer, fever and neutropenia: literature review

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      Abstract

      En los enfermos de cáncer, al igual que en los sujetos sépticos, existe desregulación de eventos comunes, como la inflamación, lo que limita el uso de biomarcadores para diagnosticarles sepsis. Mediante una búsqueda en la base de datos PubMed, identificamos los estudios clínicos que evaluaron la procalcitonina como biomarcador en niños con cáncer y sepsis, y analizamos sus características, ventajas y desventajas. La mayoría de los estudios sugieren que, con un punto de corte de 0,5 ng/dl a 1 mg/dl, la procalcitonina presenta una sensibilidad de 59-78%, especificidad de 76%, valor predictivo positivo de 93% y valor predictivo negativo de 45% para el diagnóstico de sepsis. Los valores de procalcitonina no se modifican con el uso de la quimioterapia o el uso de esteroides y, en los últimos años, se han obtenido resultados alentadores en su uso como biomarcador en el niño con cáncer y, particularmente, con neutropenia y fiebre.

      Translated abstract

      Among cancer and septic patients, there is a deregulation of common events such as inflammation. This fact limits the use of biomarkers to diagnose sepsis. Through a search in the PubMed database, we identified the clinical studies that evaluated procalcitonin as a biomarker among children with cancer and sepsis; we analyzed its characteristics, advantages and disadvantages. Most of the studies suggest that with a cut-off point between 0.5 ng/dl and 1 mg/dl, procalcitonin displays a sensitivity of 59-78%, a specificity of 76%, a predictive value of 93% and a negative predictive value of 45% to diagnose sepsis. The procalcitonin values were not modified by the use of chemotherapy or steroids. In the past few years, encouraging results have been obtained when using it as a biomarker in children with cancer, particularly with neutropenia and fever.

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      Procalcitonin as a biomarker of infectious diseases

       Hyuck Lee (2013)
      Traditional biomarkers, including C-reactive protein, leukocytes, erythrocyte sedimentation rate, and clinical signs and symptoms, are not sufficiently sensitive or specific enough to guide treatment decisions in infectious febrile diseases. Procalcitonin (PCT) is synthesized by a large number of tissues and organs in response to invasion by pathogenic bacteria, fungi, and some parasites. A growing body of evidence supports the use of PCT as a marker to improve the diagnosis of bacterial infections and to guide antibiotic therapy. Clinically, PCT levels may help guide the need for empirical antibiotic therapy, source control for infections, and duration of antibiotic therapy. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and to discuss the reliability of this marker in order to provide physicians with an overview of the potential for PCT to guide antibiotic therapy.
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        Developing e-Bug web games to teach microbiology

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          Changing pattern of treatment policies invalidates the use of C-reactive protein level and hyponatremia as indicators of sepsis in children with malignancies.

          We evaluated serum C-reactive protein (CRP) level and serum sodium concentration as early indicators of bacteremia in neutropenic children in two different series in 1983-1984 (49 bacteremias) and 1989-1990 (29 bacteremias). During the earlier period, the goal was to avoid unnecessary antimicrobial therapy. Currently a neutropenic patient is placed on antimicrobial therapy at the first sign of fever. In 1983-1984 the serum CRP concentration was elevated in every case, whereas in 1989-1990 it was normal in 34% cases (P = .0001). Hyponatremia was detected on admission in 84% and 52% cases (P = .0001). The urinary sodium concentration was elevated in most cases. The mortality in bacteremia was 22% in 1983-1984 compared to 3% (P = .025) in 1989-1990. Prompt initiation of empirical antimicrobial therapy in children with fever and neutropenia invalidates the use of hyponatremia and an elevated CRP level as early indicators of sepsis.
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            Author and article information

            Affiliations
            [1 ] Programa de Doctorado en Ciencias de la Salud, concentración en Enfermedades Infecciosas
            [2 ] Petróleos Mexicanos
            [3 ] Centro de Investigación sobre Enfermedades Infecciosas
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            aap
            Archivos argentinos de pediatría
            Arch. argent. pediatr.
            Sociedad Argentina de Pediatría (Buenos Aires )
            1668-3501
            January 2015
            : 113
            : 1
            : 46-52
            S0325-00752015000100009
            10.5546/aap.2015.46

            http://creativecommons.org/licenses/by/4.0/

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            Product Information: SciELO Argentina
            Categories
            PEDIATRICS

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