Plasma IL-8 and IL-6 levels can be used to define a group with low risk ofsepticaemia among cancer patients with fever and neutropenia

The standard therapy for patients with fever and chemotherapy-related neutr openia is hospitalization and infusion of broad-spectrum antibiotics. Early discharge of a defined group of patients at low risk for septicaemia would be of great advantage for these patients. Ih this study plasma interleukin -8 (IL-8) and interleukin-6 (IL-6) levels measured at start of fever (n = 7 2) could define a low-risk group of febrile patients with neutropenia due t o chemotherapy. For this purpose we collected and analysed data on 72 fever episodes from 53 patients with chemotherapy-related neutropenia, aged betw een 1 and 66 years. Of the 72 episodes, 18 were classified as bacteraemia a nd/or clinical sepsis (sepsis group), The IL-6 and IL-8 plasma concentratio n were significantly increased in patients with chemotherapy-related neutro penia and fever due to bacteraemia versus fever of non-bacterial origin (P = 0.043 and P = 0.022 respectively). Logistic regression analysis, with sep sis as the outcome variable, revealed significant effects of age combined w ith either IL-6 or IL-8. Sepsis occurrence was lowest for patients <16 year s and highest in patients between 16 and 50 years, and was higher in patien ts with increased IL-6 (P = 0.032) or IL-8 (P = 0.049). No significant effe ct of leucocyte count, C-reactive protein, sex or underlying malignancy at presentation was detected. The plasma IL-6 and IL-8 levels were fairly stro ngly correlated (Pearson r = 0.62). Using a cut-off value with 100% sensiti vity, both IL-8 and IL-6 could define a low-risk group of neutropenic patie nts of 28% (CI 15-40%) at the start of the febrile period. Intervention stu dies are warranted to confirm this result and to investigate whether an ear ly discharge based on IL-8 or IL-6 measurement is safe, increases the quali ty of life, and results in cost savings.