Lipopolysaccharide-binding protein: a possible diagnostic marker for Gram-negative bacteremia in neutropenic cancer patients.
OBJECTIVE
Cancer patients with febrile neutropenia after chemotherapy have a variable risk of bacterial infection. Especially Gram-negative bacteremia is associated with high mortality and/or morbidity. Early diagnosis of patients with Gram-negative bacteremia at the onset of febrile neutropenia is potentially useful in tailoring therapy.


METHODS
Prospective study at the Department of Pediatric Oncology and Internal Medicine of a university hospital.


METHODS
Were analyzed 66 febrile neutropenic episodes in 57 adults and children. Patients were divided into four groups: those with Gram-negative bacteremia, Gram-positive bacteremia, clinical sepsis, or fever of unknown origin.


RESULTS
Plasma lipopolysaccharide-binding protein (LBP) and C-reactive protein (CRP) concentrations were determined. LBP at the onset of febrile neutropenia was significantly higher in patients with Gram-negative bacteremia than those with fever of unknown origin and those with Gram-positive bacteremia. Using a cutoff value for LBP proved to have much greater sensitivity, specificity, and positive and negative predictive value for Gram-negative bacteremia than the best cutoff value for CRP.


CONCLUSIONS
An initial high LBP level might predict Gram-negative bacteremia in cancer patients with febrile neutropenia. These results may have potential clinical impact by allowing therapy to be initiated for these patients at a very early stage.
Oude Nijhuis
Claudi S M
CSM
Division of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Vellenga
Edo
E
Division of Hematology, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands.
Daenen
Simon M G J
SMGJ
Division of Hematology, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands.
van der Graaf
Winette T A
WTA
Division of Medical Oncology, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands.
Gietema
Jourik A
JA
Division of Medical Oncology, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands.
Groen
Harry J M
HJM
Division of Pulmonary Diseases, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands.
Kamps
Willem A
WA
Division of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
de Bont
Eveline S J M
ESJM
Division of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. e.s.j.m.de.bont@bkk.azg.nl.
D000209:Acute-Phase Proteins; D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000378:metabolism; D002352:Carrier Proteins / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005335:Fever of Unknown Origin / Q000097:blood; D016905:Gram-Negative Bacterial Infections / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000097:blood; D006801:Humans; D007223:Infant; D008297:Male; D008562:Membrane Glycoproteins; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced* / Q000150:complications; D011446:Prospective Studies; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D000970:Antineoplastic Agents; D002097:C-Reactive Protein; D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein