title: Plasma presepsin level is an early diagnostic marker of severe febrile neutropenia in hematologic malignancy patients.
abstract: Febrile neutropenia (FN) is a common infectious complication in chemotherapy. The mortality of FN is higher in hematologic malignancy patients, and early diagnostic marker is needed. Presepsin is a prompt and specific marker for bacterial sepsis, but its efficacy in severe febrile neutropenia (FN) is not well confirmed. We tried to clarify whether it is a useful maker for early diagnosis of FN in patients during massive chemotherapy.
  
  
  
  We measured plasma presepsin levels every 2-3 day in FN cases and evaluated its change during the course of massive chemotherapy. The patients had hematologic malignancy or bone marrow failure, and in all cases, neutropenia was severe during the episode. The baseline levels, onset levels, increase rate at FN onset, and onset / baseline ratio were evaluated for their efficacy of early FN diagnosis.
  
  
  
  Eleven episodes of bacteremia (six gram negatives and five gram positives) in severe neutropenia were analyzed in detail. While plasma presepsin level was strongly associated to the CRP level (r = 0.61, p < 0.01), it was not associated with the absolute WBC count (r = -0.19, p = 0.19), absolute neutrophil count (r = -0.11, p = 0.41) or absolute monocyte count (r = -0.12, p = 0.40). The average of onset presepsin level was 638 ± 437 pg/mL and the cutoff value (314 pg/mL) has detected FN onset in 9 of 11 cases. The two cases undetected by presepsin were both Bacillus species bacteremia.
  
  
  
  Plasma presepsin level is a reliable marker of FN even in massive chemotherapy with very low white blood cell counts. Closer monitoring of this molecule could be a help for early diagnosis in FN. But bacteremia caused by Bacillus species was an exception in our study.
authors.affiliation: Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. ykoizumi@aichi-med-u.ac.jp.|Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, 520-2192, Japan. ykoizumi@aichi-med-u.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Koizumi
authors.affiliation: Department of Laboratory Medicine, Shiga University of Medical Science, Otsu, 520-2192, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Laboratory Medicine, Shiga University of Medical Science, Otsu, 520-2192, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Shigeta
authors.affiliation: Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Okuno
authors.affiliation: Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Minamiguchi
authors.affiliation: Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kito
authors.affiliation: Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Hodohara
authors.affiliation: Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yamagishi
authors.affiliation: Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Andoh
authors.affiliation: Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujiyama
authors.affiliation: Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Mikamo
mesh_terms: D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers / Q000097:blood*; D042241:Early Diagnosis; D064147:Febrile Neutropenia / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007958:Leukocyte Count; D018950:Lipopolysaccharide Receptors / Q000097:blood*; D009503:Neutropenia / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D010446:Peptide Fragments / Q000097:blood*
chemical_list: D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; C000594167:presepsin protein, human
keywords: Bacteremia; CD14; Chemotherapy; Febrile neutropenia; Presepsin(soluble CD14-ST)