Role of Interleukin-6 (IL-6) as Early Predictor of Bacteremia in Febrile Neutropenia among The Children with Acute Leukemia

Background: Febrile neutropenia (FN) is a significant complication of acute leukemia, leading to morbidity and mortality. Early detection of bacteremia is crucial for timely management, but traditional culture methods are time1consuming. Previous studies have suggested that Interleukin-6 (IL-6) may serve as an early and convenient marker for predicting bacteremia in children with hematological malignancies and febrile neutropenia. This study aimed to investigate the role of IL-6 in predicting bacteremia among children with acute leukemia and febrile neutropenia. Methods: A cross-sectional study was conducted at the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), over a 12-month period following ethical approval. A total of 50 children with acute leukemia and febrile neutropenia were enrolled based on specific criteria. Written informed consent was obtained from parents and detailed histories, clinical examinations, and relevant investigations were performed. Data were collected using a semi-structured questionnaire and analyzed using SPSS 22.0. Results: The study included patients with a mean age of 5.96±3.69 (SD) years, with a male predominance 31(62%). Among the patients, 23(46%) had microbiologically documented infection (MDI),15(30%) had clinically documented infection (CDI), and12(24%) had fever without focus (FWF). Among the isolated organisms in MDI patients,16(69.56%) were gram-negative bacteria. The mean rank of IL-6 was higher in patients with MDI compared to CDI and FWF. IL-6 showed 87% sensitivity and 76% specificity at a cutoff value of 141.95 pg/mL in the ROC curve analysis, with an area under the curve of 0.843. Increasing IL-6 levels were associated with higher odds of bacteremia in both univariate and multivariate logistic regression analyses. No significant difference in IL-6 levels was observed between patients with gram-positive and gram-negative bacteremia. Conclusion: This study suggests that IL-6 may play a crucial role in predicting bacteremia in febrile neutropenic patients with acute leukemia. However, further multicenter case-control studies are recommended to validate these findings. Bangladesh Med Res Counc Bull 2024; 50: 24-31