Analysis Of The Infection Factors Of Childhood Acute Myeloid Leukemia During The Agranulocytosis Period After High-dose Chemotherapy

Objective: The study aims to analyze the diagnostic value of interleukin-6,high sensitivity C-reactive protein,and procalcitonin of agranulocytosis period after high-dose chemotherapyin children with acute myeloid leukemia,and to confirm the best index for the diagnosis of infection in agranulocytosis period.This study will provide theoretical evidence for the early diagnosis and prevention of infection of agranulocytosis period after high-dose chemotherapyin children with acute myeloid leukemia.Method:1 From December 2014 to December 2015,27 child patients with fever were included in this study.All the patients were confirmed by clinical manifestations,morphology,immunology,cytogenetics and molecular biology.The 27 patients(male 18 cases,female 9 cases;male:female=2:1,age ranging from 1 year and 4 months old to 14 years old;the median age 5 year and 3 months old)all underwent high-dose cytarabine therapy,and were in the agranulocytosis period(neutrophil <0.5*10~9/L).The 26 cases of patients(male 17 cases,female 9 cases;male:female=1.89:1,age ranging from 2 year and 1 months old to 14 years old;the median age 5 year and 7 months old)without fever,who were in the agranulocytosis period(neutrophil <0.5*10~9/L)after high-dose cytarabine therapy,are includedinthe control group.The venous blood samples of the patients in the fever group were collected,and blood routine test,the assay of interleukin-6(IL-6)and procalcitonin(PCT)were performed.The levels of high sensitivity C-reactive protein(hs-CRP)in the peripheral blood were also evaluated.At the same time,the blood samples of the patients in the control group were collected and examined.2 The levels of IL-6,PCT,and hs-CRP were recorded and statistical analysis was performed.The data were expressed as the median and 25 th to 75 th percentiles and were analyzed by the Mann–Whitney U test.The receiver operating characteristic curve(ROC)was used to investigate the sensitivity,specificity,the best diagnostic point(closest to the upper left corner of the ROC curve,cut-off value),positive likelihood ratio(LR+),negative likelihood ratio(LR-),positive predictive value(PV+),negative predictive value(PV-),and Youden index.P< 0.05 wasconsidered statistically significant.Result:1The comparison of test results of interleukin-6(IL-6)between in the experimental group and the control group,The median of Interleukin-6(IL-6)(the 25 th percentile,the 75 percentile digits)in the two group respectively: 33.45(24.95,66.78)pg / ml in the concurrent fever group and 16.41(7.86 21.44)pg / ml in the control group.P < 0.05 is of significance in statistics science.The comparison of test result of high sensitivity C-reactive protein(hs-CRP)between in the experimental group and the control group,The median(twenty-fifth percentile,seventy-fifth percentile)of high sensitivity C-reactive protein(hs-CRP)in the two groups respectively : 22.58(0.44,43.87)mg/L in the concurrent fever group,0.3(0.22,0.44)mg/L in the control group.P<0.05 is of significance in statistics science.The comparison of test results of procalcitonin(PCT)between in the experimental group and the control group.The median(twenty-fifth percentile,seventy-fifth percentile)of Procalcitonin(PCT)in the two groups respectively : 0.17(0.1,0.32)ng/ml in the concurrent heating group;0.01(0.01,0.02)ng/ml in the control group.P<0.05 is of significance in statistics science.The three results in the concurrent heating group are higher than in the control group.The difference is of significance in statistics science(P<0.05);2The comparison of diagnostic efficacy of interleukin-6(IL-6),high sensitive C-reactive protein(hs-CRP)and procalcitonin(PCT).The diagnostic efficiency of interleukin-6(IL-6),high sensitive C-reactive protein(hs-CRP)and procalcitonin(PCT)can be evaluatedand analysed by ROC curve.The curve(AUC)of interleukin-6(IL-6)is 0.859(P < 0.05),high sensitive C-reactive protein(hs CRP)is 0.825(P < 0.05),calcitonin prime raw(PCT)is 0.962(P < 0.05).While,the curve(AUC)of PCT is up to 0.962(P < 0.05),which is superior to interleukin-6(IL-6)and high sensitive C-reactive protein(hs-CRP).The difference is of significance in statistics science;3Compared with interleukin-6(IL-6)and high sensitive C-reactive protein(hs-CRP),procalcitonin(PCT)has better sensitivity and specificity.When the PCT cut-off value comes to 0.03ng/ml,its sensitivity is up to 96.3%,specificity up to 92.3%,Youden index up to 0.886,while,negative and positive predictive value up to 96% and 92.9%,negative and positive likelihood ratio up to 0.04 and 12.5,which are better than those of IL-6 and hs-CRP.Conclusion:1 In the early infection of agranulocytosis period after high-dose chemotherapyin children with acute myeloid leukemia,IL-6 and hs-CRP,PCT exhibited certain diagnostic value.2 PCT confers better diagnostic efficacy than that of hs-CRP and IL-6.PCT has higher sensitivity and specificity.Additionally,the authenticity of PCT diagnostic test is higher.Therefore,PCT is recommended for the early detection and screening of the early infection of agranulocytosis period after high-dose chemotherapyin children with acute myeloid leukemia.3 When the cut-off value of PCT is 0.03ng/ml,it has the maximum Youden index on the ROC,indicating the best diagnostic efficacy.