Use of inflammatory markers for early detection of bacteraemia in patients with febrile neutropenia.
The aim of the study was to evaluate the ability of procalcitonin, C-reactive protein, serum amyloid A, interleukin-6 and interleukin-8 to predict bacteraemia during the 2 first d of fever in neutropenic patients. A total of 94 febrile neutropenic episodes in 60 patients were studied. Plasma samples were analysed at 10-h intervals from the onset of fever. Clinical events were categorized into 4 groups: 1) bacteraemia caused by other agents than coagulase-negative staphylococci (non-CNS bacteraemia) (n = 21), 2) coagulase-negative staphylococci bacteraemia (n = 15), 3) microbiologically or clinically documented infection without bacteraemia (n = 26) and 4) fever of unknown origin (n = 32). In non-CNS bacteraemia all markers, except for serum amyloid A, showed significantly higher levels compared to patients with fever of unknown origin (p < 0.05). For non-CNS bacteraemia the highest negative predictive value was found for procalcitonin (94%), followed by interleukin-6 (89%), C-reactive protein (88%) and interleukin-8 (87%). Procalcitonin, with a cut-off level of 1.4 ng/ml during 10-20 h after fever onset, showed the highest positive predictive value (67%) for a non-CNS bacteraemia. In conclusion, the value of the analysed markers to predict a non-CNS bacteraemia in neutropenic patients was limited due to low sensitivity and positive predictive value. However, procalcitonin, interleukin-6, C-reactive protein, and interleukin-8 could give useful information for the clinician in excluding a non-CNS bacteraemia.
Department of Infectious Diseases, Orebro University Hospital, Stockholm, Sweden. lennart.persson2@orebroll.se
Lennart
L
Persson
Per
P
Engervall
Anders
A
Magnuson
Tomas
T
Vikerfors
Bo
B
Söderquist
Lars-Olof
LO
Hansson
Ulf
U
Tidefelt
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000682:Amyloid / Q000032:analysis; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000209:etiology; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000032:analysis; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000209:etiology; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000175:diagnosis* / Q000209:etiology; D011336:Probability; D011379:Prognosis; D011498:Protein Precursors / Q000032:analysis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D000682:Amyloid; D000970:Antineoplastic Agents; C000606589:CALCA protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide