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Abstract In childhood cancers, severe and prolonged neutropenia develops in association with the use of intensive chemotherapy protocols, which results in the onset of infections with potentially higher rates of morbidity and mortality. In childhood cancer, mortality rates associated with febrile neutropenia have decreased in recent years but not to desired levels. Despite all of these biomarkers, severity of infection and risk of mortality cannot be fully determined. Therefore, new biomarkers have been investigated. As a new biomarker, the predictive and prognostic values of adrenomedullin in pulmonary, cardiovascular, and rheumatological diseases have been reported. The aim of this study is to evaluate the importance of serum adrenomedullin levels in diagnosis of febrile neutropenia in pediatric patients with malignancy. This study comprised 25 patients admitted to the Hematology and Oncology Unit, Menoufia University Hospital, diagnosed as acute lymphoblastic leukemia and have episode of febrile neutropenia. These patients were 15 males and 10 females with a mean± SD (4.79 ±3.81)age ranging from 1-14 years. In each episode of FN, complete history taking and careful physical examination were done with particular attention to areas that may hide a site of infection unless closely examined particularly the oral cavity and the perianal area. The following laboratory parameters were done in each attack of FN : a) Complete blood picture with differential count. b) C-reactive protein level in 1st and 5th day. 90 c) Blood culture for both bacteria and fungi. d) Adrenomedallin level in 1st and 5th day. e) Chest x-ray. f) Lab. function (Na, K, SGPT, Creatinine level). Patients were 15 males and 10 females with a age ranging from 1-14 (mean ± SD ) (4.79 ± 3.81). All of cases where presented with chest infection (pneumonia) and 14 (56%) of their X-ray showing pneumonia while the other 11(44%) showed nothing. Regarding the organisms Causing infection in Febrile Neutropenic attack, 17(68%) were G-ve bacilli while 8(32%) were fungal infection, (62%) were Aspergillus spp & (38%) were candida. Neutrophils, platelets and WBS were increase in 5th day than 1st day (p.value >0.001), while in HG had no significantly difference between 1st and 5th day of febrile neutropenia (p.value < 0.05). There was no significant changes in level of Na, K, Creatinine and SGPT in 1st and 5th day of febrile neutropenia, (P.value <0.05). Adrenomedallin was significantly higher in 5th day than 1st day of febrile neutropenia (P.value <0.001), but CRP was significantly lower in 5th day than 1st day of febrile neutropenia (P.value < 0.05). There was no significant correlation between CRP or adrenomedallin VS days of neutropenia or type of culture (p.value <0.05). Adrenomedallin was more sensitive (93.33%) than CRP (80%) in febrile neutropenic episode. As regarding the specificity of the markers in FN, the Adrenomedallin was more specific (85.4%) than CRP (73%). The ROC curve also showed that the positive predictive value (PPV) of 91 Adrenomedallin in this study was (90%) which was higher than the PPV of CRP (89%). The area under the curve (AUC) in Adrenomedallin was (0.94) while in CRP was (0.76). There was no significant correlation between CRP VS Adrenomedallin in 1st or 5th day of febrile neutropenia (p.value <0.05). from this study we concluded that: Adrenomedallin is a new marker which increased in 5th day than 1st day in febrile neutropenic episode in pediatric malignancy, and more sensitive and specific than CRP. Also CRP stills an effective cheap marker that should be used in febrile neutropenic episode. |