title: Asymmetric dimethylarginine in the assessment of febrile neutropenia in hematological patients.
abstract: Asymmetric dimethylarginine (ADMA) has been recognized as an independent prognostic factor for sepsis mortality in intensive care units. No data are available on kinetics or prognostic value of ADMA in hematological patients. We evaluated the ability of ADMA to act as a predictor for complicated course of febrile neutropenia, defined as bacteremia and/or septic shock in adult hematological patients receiving intensive chemotherapy. This prospective study included 87 adult hematological patients with febrile neutropenia after an intensive chemotherapy for acute myeloid leukemia (AML) or after an autologous stem cell transplantation (ASCT). Plasma ADMA and serum C-reactive protein (CRP) levels were measured from the onset of fever (d0) and for 2 days (d1-d2) thereafter. The levels of ADMA were stable or had only minimal changes during the study period. There was no difference between the levels at any time-point in patients having complicated course compared to those without it. On the other hand, CRP levels were significantly higher on d1 (p = 0.016) in patients with bacteremia and/or septic shock than in those without. ADMA was not able to differentiate hematological patients with a complicated course from those without complications. Elevated ADMA levels are probably associated with organ dysfunction, which is rare in this group of patients, of whom about 95% can be successfully managed at the hematology ward.
authors.affiliation: a Department of Internal Medicine , Central Hospital of Central Finland , Jyväskylä , Finland.
authors.forename: Marika
authors.initials: M
authors.lastname: Lappalainen
authors.affiliation: b Department of Medicine , Kuopio University Hospital , Kuopio , Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Hämäläinen
authors.affiliation: b Department of Medicine , Kuopio University Hospital , Kuopio , Finland.|c Institute of Clinical Medicine/Internal Medicine , University of Eastern Finland , Kuopio , Finland.
authors.forename: Auni
authors.initials: A
authors.lastname: Juutilainen
authors.affiliation: b Department of Medicine , Kuopio University Hospital , Kuopio , Finland.
authors.forename: Irma
authors.initials: I
authors.lastname: Koivula
authors.affiliation: d Department of Clinical Chemistry , University of Eastern Finland and Eastern Finland Laboratory Centre , Kuopio , Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.affiliation: b Department of Medicine , Kuopio University Hospital , Kuopio , Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D064147:Febrile Neutropenia / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; C018524:N,N-dimethylarginine; D002097:C-Reactive Protein; D001120:Arginine
keywords: ADMA; C-reactive protein; biomarker; febrile neutropenia; hematology; sepsis