Diagnostic and Prognostic Utility of Serum Presepsin, CRP, and Procalcitonin in Pediatric Febrile Neutropenia

DD MMMM YYYY MMMM YYYY Background: Febrile neutropenia (FN) is a common and potentially life-threatening complication in pediatric oncology. Early identification of sepsis is critical for timely intervention. Presepsin (PSP), a soluble CD14 subtype, has been proposed as a potential biomarker for infection. This study aimed to evaluate the diagnostic and prognostic value of PSP compared with CRP and procalcitonin (PCT) in pediatric cancer patients with FN. Methods: This prospective observational study included 60 pediatric oncology patients with FN and 20 age-matched febrile controls. PSP, CRP, and PCT levels were measured at baseline, onset of fever, and 48 hours post-onset. ROC curve analysis determined optimal PSP cut-off values. Statistical analyses included Mann–Whitney U, Spearman correlation, and generalized linear models. Results: CRP and PCT levels increased significantly in both groups during febrile episodes (p<0.001). PSP levels increased significantly only in febrile controls (p<0.001) but not in oncology patients (p=0.247). In FN patients, a PSP cut-off of 2768 pg/mL yielded 34.4% sensitivity, 84.4% specificity, and 85% negative predictive value (NPV). PSP did not significantly correlate with CRP or PCT. Conclusions: While PSP demonstrated high NPV, its low sensitivity limits its utility as a standalone biomarker in pediatric oncology patients with FN. CRP and PCT remain more reliable for clinical decision-making. Larger multicenter studies are warranted to validate PSP's role in multimodal risk assessment.