Evaluation of neutropenic fever: Value of serum and plasma parameters in clinical practice

Treatment-related mortality due to infectious complications following poten tially curable aggressive chemotherapy remains a major clinical problem. Ho wever, the diagnosis of neutropenic infections is difficult. Although it is common practice to institute empirical broad-spectrum antibiotics in neutr openic fever, liberal use of antibiotics may contribute to increasing resis tance and superinfection such as systemic mycosis. Clinicians are searching for a highly specific and sensitive marker indicating early infection. Ser um concentrations of several acute-phase proteins (C-reactive protein, seru m amyloid A), proinflammatory cytokines (TNF alpha, IL-1, IFN gamma, IL-6, IL-8), soluble adhesion molecules (soluble E-selectin, vascular cell adhesi on molecule 1, intercellular adhesion molecule 1) and more recently procalc itonin have been investigated as to whether these may contribute to identif ying infections as the cause of neutropenic fever. Unfortunately, at presen t, based on the small and inconsistent amount of data available from the li terature one is tempted to conclude that the predictive values of all these parameters are too low to influence the clinically based initial treatment decisions in patients with neutropenic fever. Copyright (C) 2000 S. Karger AG, Basel.