The Prognostic Value of Serial C-Reactive Protein Monitoring in Pediatric Febrile Neutropenia

A Single-Center Prospective Cohort Study

Abstract

Background:  In pediatric cancer patients, predicting the occurrence of sepsis and septic shock in the context of febrile neutropenia (FN) remains an important clinical challenge. While C-reactive protein (CRP) is one of the most widely used clinical biomarkers, further studies are needed to identify its utility in predicting clinical deterioration in this specific population. The aim was to assess the prognostic potential of initial (0h) and 24-hour (24h) CRP kinetics in predicting sepsis severity, ICU admission, and mortality in pediatric cancer patients presented with FN.

Methods:  We performed a prospective observational study of 242 pediatric cancer patients presenting with FN. We analyzed CRP dynamics, Pediatric Sequential Organ Failure Assessment (pSOFA) scores, microbiological profiles, and clinical outcomes including sepsis progression, septic shock, admission to the ICU, and 28-day mortality.

Results:  The cohort (median age 9.0 years) demonstrated that there was a meaningful increase in mean CRP from 89.4 mg/L at presentation to 116.4 mg/L at 24 hours (P < 0.05). Elevated CRP levels were strongly correlated with disease severity; patients requiring ICU admission (n=50) and those developing septic shock (n=51) exhibited significantly higher CRP levels at both time points. The 28-day mortality rate was 12.0% (n=29). Non-survivors demonstrated persistently elevated or rising CRP trends compared to survivors. Gram-positive bacteremia was associated with the highest CRP level.

Conclusion:  Serial CRP monitoring provides critical prognostic data in pediatric FN. A rising CRP trajectory over the first 24 hours is a potent indicator of clinical deterioration, supporting its use in identifying high-risk patients requiring escalated care.