Role of neutrophil elastase in predicting infection among children with chemotherapy-induced febrile neutropenia.

Background: Infection is a significant cause of death following chemotherapy-induced febrile neutropenia (FN). Neutropenia and compromised neutrophil function are the primary reasons for the decreased defense against infections.

Purpose: This study aimed to evaluate the significance of neutrophil elastase (NE) in predicting the outcomes of childhood hematological malignancies with FN.

Methods: The study included 64 patients with FN and 64 healthy children matched for age and sex as controls. The patients were selected from the Hematology and Oncology Unit, Menoufia University, Pediatric Department, and Tanta Oncology Institute. Complete blood counts, C-reactive protein (CRP) levels, NE levels, and blood cultures for bacteria and fungi were performed.

Results: The levels of CRP and NE were increased among children with FN; of them, 21.9% had Gram-negative bacteremia, 17.2% had Gram-positive bacteremia, and 3.1% had Candidemia. NE level was increased in patients with bacterial infections, with a significant positive correlation with duration of FN. NE level had a cutoff of 6.5, with an area under the curve of 0.899, sensitivity of 83.33%, and specificity of 87.50% signifying a higher risk of mortality compared to other variables.

Conclusion: NE levels were elevated in children with FN, suggesting its usefulness for the early detection of infection that could decrease infection-related morbidity and mortality.