Research Article

A Systematic Review of Three Biomarkers to Aid in the Assessment of Outcomes for Children and Young People with Cancer that are Febrile Neutropenic


  • Sarah Griffin Great Ormond Street Hospital, United Kingdom


For paediatric patients with cancer, febrile neutropenia (FN) is the most common complication of treatment. It requires inpatient hospitalisation and treatment with empirical broad-spectrum antibiotics. Approximately 20-30% of febrile neutropenic patients have a documented infection, thus needing antibiotics. For the rest, it is suggested that the cause of FN could be a viral or fungal infection, the malignancy itself, drug related or the result of a blood transfusion reaction as examples, therefore not requiring antibiotics. With no risk-stratification tool in use in practice to distinguish between patients who are at high or low risk of bacterial infections, recent studies have focused on identifying clinical and laboratory markers for this. This systematic review will focus on three biomarkers, C-reactive protein (CRP), presepsin (sCD14-ST) and lactate, to find their sensitivities and specificities for diagnosing bacterial infections and thus help determine the risk of poor outcomes for patients with FN. This review has systematically searched for relevant primary research papers. These studies have been critically appraised using a validated critical appraisal tool. Data from these studies were then extracted using a data extraction form, and evidence summarised. The findings have been interpreted, and the implications to practice and research are discussed. 1051 febrile neutropenic episodes from 743 children from different countries were analysed. In the majority of studies (75%), acute lymphoblastic leukaemia was the most frequent diagnosis. Eight of the studies in this review are looking at CRP. Two studies are looking at lactate, and five review presepsin. Lactate is a sensitive and specific biomarker with a lactate level ≥ 2mmol/L and >2.5mmol/L showed sensitivities of 81% and 80% and specificities of 83% and 92.1%, respectively. Presepsin and CRP had mixed results for its sensitivity and specificity. Lactate and CRP are useful biomarkers for assessing the outcomes of children with FN and could be added to a CDR. This review cannot confirm that presepsin is a useful biomarker for practice and, therefore, cannot justify adding it to a CDR.

Article information


British Journal of Nursing Studies

Volume (Issue)

4 (1)





How to Cite

Griffin, S. (2024). A Systematic Review of Three Biomarkers to Aid in the Assessment of Outcomes for Children and Young People with Cancer that are Febrile Neutropenic. British Journal of Nursing Studies, 4(1), 12–42.



febrile neutropenia, biomarkers, children, cancer