title: Biomarkers for bacteremia and severe sepsis in hematological patients with neutropenic fever: multivariate logistic regression analysis and factor analysis.
abstract: We compared biomarkers and their changes as predictors for bacteremia and severe sepsis during neutropenic fever after intensive chemotherapy in hematological patients. Serum C-reactive protein (CRP), semi-quantative procalcitonin, aminoterminal pro-brain natriuretic peptide (NT-proBNP), cortisol, lactate, plasma antithrombin and fibrinogen were measured daily from day 0 to day 3/day 4 in 89 neutropenic fever episodes of 65 hematological patients. The best predictors for bacteremia and gram-negative bacteremia were procalcitonin and its change, with odds ratios (ORs) and 95% confidence intervals of 2.63 (1.56-4.44) and 3.20 (1.77-5.80) for bacteremia and 4.14 (2.00-8.58) and 5.04 (2.18-11.63) for gram-negative bacteremia, respectively. For severe sepsis, the best predictors were CRP and fibrinogen, with ORs of 1.94 (1.07-3.52) and 1.92 (1.05-3.54). Factor analysis provided two predictive factors: procalcitonin-NT-proBNP-antithrombin factor predicted gram-negative bacteremia and CRP-fibrinogen predicted severe sepsis. Applying a combination of markers reflecting different aspects of infection might improve the recognition of risk for complications in patients with neutropenic fever.
authors.affiliation: Institute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, Finland. auni.juutilainen@kuh.fi
authors.forename: Auni
authors.initials: A
authors.lastname: Juutilainen
authors.forename: Sari
authors.initials: S
authors.lastname: Hämäläinen
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.forename: Taru
authors.initials: T
authors.lastname: Kuittinen
authors.forename: Tapio
authors.initials: T
authors.lastname: Nousiainen
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
authors.forename: Irma
authors.initials: I
authors.lastname: Koivula
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D005163:Factor Analysis, Statistical; D005260:Female; D005334:Fever / Q000209:etiology*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D018805:Sepsis / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D015415:Biomarkers