Evaluation of procalcitonin, neopterin, C-reactive protein, IL-6 and IL-8 as a diagnostic marker of infection in patients with febrile neutropenia.
Infectious complications in neutropenic patients are a major cause of morbidity and mortality. Clinical signs are unspecific and fever can be attributed to other causes. Inflammatory biomarkers have emerged as potentially useful in diagnosis of bacterial and fungal infection. Levels of several biomarkers were measured in patients with hematological malignancy at diagnosis and at the beginning of neutropenia due to cytostatic treatment or after hematopoietic stem cell transplantation, and daily until 6 days after presenting fever. Procalcitonin (PCT) and neopterin levels were not elevated at diagnosis or at the beginning of neutropenia. C-reactive protein (CRP) was moderately elevated. PCT levels were significantly higher in patients with Gram-negative bacteremia at 24-48 h after the onset of fever. Patients with probable fungal infection presented elevated PCT values when fever persisted for more than 4-5 days. CRP was more sensitive to predict bacteremia (both Gram-positive and Gram-negative) but the specificity was low. Neither neopterin, IL-6 nor IL-8 presented significant differences according to the origin or etiology of fever. Since it showed a high negative predictive value of Gram-negative bacteremia, clinical prediction rules that attempt to predict a high risk of severe infection might be improved by including measurement of PCT.
Prat
Cristina
C
Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. cprat.germanstrias@gencat.net
Sancho
Juan Manuel
JM
Dominguez
Josep
J
Xicoy
Blanca
B
Gimenez
Montse
M
Ferra
Christelle
C
Blanco
Silvia
S
Lacoma
Alicia
A
Ribera
Josep Maria
JM
Ausina
Vicenc
V
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005334:Fever / Q000209:etiology*; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis; D019798:Neopterin / Q000097:blood; D009503:Neutropenia / Q000150:complications*; D009894:Opportunistic Infections / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood
D015415:Biomarkers; C000606589:CALCA protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D011498:Protein Precursors; D019798:Neopterin; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide