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

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Abstract
The standard therapy for patients with fever and chemotherapy‐related neutropenia 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. In this study plasma interleukin‐8 (IL‐8) and interleukin‐6 (IL‐6) levels measured at start of fever (n = 72) could define a low‐risk group of febrile patients with neutropenia due to chemotherapy. For this purpose we collected and analysed data on 72 fever episodes from 53 patients with chemotherapy‐related neutropenia, aged between 1 and 66 years. Of the 72 episodes, 18 were classified as bacteraemia and/or clinical sepsis (sepsis group). The IL‐6 and IL‐8 plasma concentration were significantly increased in patients with chemotherapy‐related neutropenia and fever due to bacteraemia versus fever of non‐bacterial origin (P = 0.043 and P = 0.022 respectively). Logistic regression analysis, with sepsis as the outcome variable, revealed significant effects of age combined with either IL‐6 or IL‐8. Sepsis occurrence was lowest for patients P = 0.032) or IL‐8 (P = 0.049). No significant effect of leucocyte count, C‐reactive protein, sex or underlying malignancy at presentation was detected. The plasma IL‐6 and IL‐8 levels were fairly strongly correlated (Pearson r = 0.62). Using a cut‐off value with 100% sensitivity, both IL‐8 and IL‐6 could define a low‐risk group of neutropenic patients of 28% (CI 15–40%) at the start of the febrile period. Intervention studies are warranted to confirm this result and to investigate whether an early discharge based on IL‐8 or IL‐6 measurement is safe, increases the quality of life, and results in cost savings.

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