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Zheng H, Luo Z, Yi Y, Liu K, Huo Z, You Y, Li H, Tang M. Assessment value of interleukin-6, procalcitonin, and C-reactive protein early kinetics for initial antibiotic efficacy in patients with febrile neutropenia: A prospective study. Cancer Med 2024; 13:e7307. [PMID: 38967137 PMCID: PMC11224913 DOI: 10.1002/cam4.7307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND This study aims to investigate the early kinetics of interleukin 6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) on initial antibiotic efficacy in hematological disorder patients with febrile neutropenia (FN). METHODS A total of 40 patients with 43 episodes of FN were enrolled and divided into initial antibiotic effective group (IAE group, n = 24) and initial antibiotic ineffective group (IAI group, n = 19). The levels of IL-6, PCT, and CRP before antibacterial treatment (T0), and 12 h (T1), 24 h (T2), 48 h (T3), and 72 h (T4) post-antibacterial treatment were determined, respectively. Furthermore, the receiver operating characteristic curve (ROC) analysis was performed to evaluate the clinical value of indicators. RESULTS In IAE group, the IL-6 levels gradually decreased from T0 to T4, and the CRP levels significantly decreased at 48 to 72 h, whereas both IL-6 and CRP remained at high levels in the IAI group. The PCT levels in both groups increased at the early stage of anti-infection (T1-T2) and reached to peak at T1-T2 in effective group. ROC curve analysis identified IL-6 as a predictive biomarker for initial antibiotic efficacy at 12, 48, and 72 h after treatment, with the AUC of 0.698, 0.744, and 0.821, respectively. In addition, CRP demonstrated predictive ability of initial antibiotics against infection at 24, 48, and 72 h after therapy, with the AUC of 0.724, 0.741, and 0.797, respectively. ROC curve analysis of percentage changes demonstrated that IL-6 percentage change showed predictive ability of antibiotic efficacy at the early stage, and both the IL-6 and CRP percentage changes showed the predictive ability of antibiotic efficacy 48 or 72 h after antibiotics therapy. CONCLUSION This study confirmed IL-6 and CRP levels, and the percentage change in IL-6 as the biomarkers for initial antibiotic efficacy prediction in hematological disorder patients with FN.
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Affiliation(s)
- Haifeng Zheng
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Zimian Luo
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Yafei Yi
- Department of HematologyChangsha Central HospitalChangshaChina
| | - Kang Liu
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Zhongjun Huo
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Yaqin You
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Hujiao Li
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
| | - Min Tang
- Department of HematologyCentral Hospital of XiangtanXiangtanChina
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Halder A, Liesenfeld O, Whitfield N, Uhle F, Schenz J, Mehrabi A, Schmitt FCF, Weigand MA, Decker SO. A 29-mRNA host-response classifier identifies bacterial infections following liver transplantation - a pilot study. Langenbecks Arch Surg 2024; 409:185. [PMID: 38865015 PMCID: PMC11169022 DOI: 10.1007/s00423-024-03373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/01/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Infections are common complications in patients following liver transplantation (LTX). The early diagnosis and prognosis of these infections is an unmet medical need even when using routine biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT). Therefore, new approaches are necessary. METHODS In a prospective, observational pilot study, we monitored 30 consecutive patients daily between days 0 and 13 following LTX using the 29-mRNA host classifier IMX-BVN-3b that determine the likelihood of bacterial infections and viral infections. True infection status was determined using clinical adjudication. Results were compared to the accuracy of CRP and PCT for patients with and without bacterial infection due to clinical adjudication. RESULTS Clinical adjudication confirmed bacterial infections in 10 and fungal infections in 2 patients. 20 patients stayed non-infected until day 13 post-LTX. IMX-BVN-3b bacterial scores were increased directly following LTX and decreased until day four in all patients. Bacterial IMX-BVN-3b scores detected bacterial infections in 9 out of 10 patients. PCT concentrations did not differ between patients with or without bacterial, whereas CRP was elevated in all patients with significantly higher levels in patients with bacterial infections. CONCLUSION The 29-mRNA host classifier IMX-BVN-3b identified bacterial infections in post-LTX patients and did so earlier than routine biomarkers. While our pilot study holds promise future studies will determine whether these classifiers may help to identify post-LTX infections earlier and improve patient management. CLINICAL TRIAL NOTATION German Clinical Trials Register: DRKS00023236, Registered 07 October 2020, https://drks.de/search/en/trial/DRKS00023236.
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Affiliation(s)
- Amelie Halder
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | | | | | - Florian Uhle
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Judith Schenz
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Arianeb Mehrabi
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral & Transplantation Surgery, Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Felix C F Schmitt
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Markus A Weigand
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Sebastian O Decker
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Wang S, Song Y, Shi N, Yin D, Kang J, Cai W, Duan J. Characteristics, Outcomes, and Clinical Indicators of Bloodstream Infections in Neutropenic Patients with Hematological Malignancies: A 7-Year Retrospective Study. Infect Drug Resist 2023; 16:4471-4487. [PMID: 37449245 PMCID: PMC10337688 DOI: 10.2147/idr.s413454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose The aim of this study was to investigate the current epidemiology, its changes during the study years, and inflammatory biomarkers of bacterial bloodstream infections (BSIs) in neutropenic patients with hematological malignancies. We assessed mortality risk factors and multidrug-resistant (MDR) gram-negative BSI predictors. Patients and Methods We conducted a retrospective study from January 2015 to December 2021, which included adult neutropenic oncohematological patients with confirmed BSIs. We used univariable and multivariable analyses to analyze the risk factors. Each index's reliability for bacterial BSI diagnosis was assessed using the receiver-operating characteristic curve and area under the curve. Results A total of 514 isolates were obtained from the 452 patients. The average mortality was 17.71%. Gram-negative organisms were the predominant causes of BSI. Escherichia coli was the most common microorganism (49.90%). The overall variation trend of the isolation rate of MDR and carbapenem-resistant gram-negative bacteria increased. Multivariate analysis indicated that: 1) neutropenia that lasted for more than 7 days, patients ≥ 60 years of age, septic shock, hospitalization for >20 days, BSI with a carbapenem-resistant strain, and treatment with linezolid or vancomycin in infections lasting less than 30 days were independent mortality risk factors; 2) severe neutropenia exceeding 7 days, unreasonable empirical therapy, and receipt of aminoglycosides or 3rd or 4th generation cephalosporins in infections lasting less than 30 days were independent risk factors of MDR gram-negative bacteria. Procalcitonin, absolute neutrophil count, and white blood cell indicate higher diagnostic accuracy for BSIs. Moreover, bacteria time to detection was better at differentiating Gram-negative and Gram-positive bacterial infections. Conclusion We analyzed the risk factors for BSI neutropenic patients with hematological malignancies, the distribution of bacteria, antibiotic resistance, and the changes in clinical parameters. This single-center retrospective study may provide clinicians with novel insights into the diagnosis and treatment of BSI to improve future clinical outcomes.
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Affiliation(s)
- Shuyun Wang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Yan Song
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Nan Shi
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Pharmacy, School of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Donghong Yin
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jianbang Kang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Wanni Cai
- Department of Pharmacy, School of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jinju Duan
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
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Floeystad HK, Holter JC, Husebye E, Siljan WW, Berild D, Holm AM, Heggelund L. Nausea Predicts Bacteremia in Immunocompetent Patients with Pneumococcal Community-Acquired Pneumonia: Secondary Data Analysis from a Prospective Cohort. J Clin Med 2023; 12:3924. [PMID: 37373619 DOI: 10.3390/jcm12123924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND In pneumococcal community-acquired pneumonia (CAP), bacteremia is associated with increased mortality, but initial clinical severity scores frequently fail to identify bacteremic patients at risk. We have previously shown that gastrointestinal symptoms are common among patients admitted to the hospital with pneumococcal bacteremia. The aim of this study was to examine gastrointestinal symptoms and inflammatory responses in bacteremic and non-bacteremic pneumococcal CAP in a prospective cohort of immunocompromised and immunocompetent patients hospitalized with CAP. METHODS Logistic regression analysis was used to estimate the predictive value of gastrointestinal symptoms for pneumococcal bacteremia in patients with CAP. The Mann-Whitney test was used to compare inflammatory responses in patients with bacteremic vs. non-bacteremic pneumococcal CAP. RESULTS Eighty-one patients with pneumococcal CAP were included, of whom 21 (26%) had bacteremia. Immunocompetent patients with pneumococcal CAP had an odds ratio of 16.5 (95% CI 3.0-90.9, p = 0.001) for bacteremia if nausea was present, whereas no such association was found in the immunocompromised patients (OR 0.22, 95% CI 0.02-2.05, p = 0.18). The serum levels of C-reactive protein, procalcitonin and interleukin 6 were significantly higher in the patients with bacteremic pneumococcal CAP compared to non-bacteremic pneumococcal CAP patients (p < 0.001, p = 0.005, and p = 0.019, respectively). CONCLUSIONS In immunocompetent patients hospitalized with pneumococcal CAP, nausea may be a predictor of bacteremia. Bacteremic pneumococcal CAP patients display an increased inflammatory response compared to non-bacteremic pneumococcal CAP patients.
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Affiliation(s)
- Hans Kristian Floeystad
- Department of Internal Medicine, Sorlandet Hospital, 4615 Kristiansand, Norway
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Jan Cato Holter
- Department of Microbiology, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Einar Husebye
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - William Ward Siljan
- Department of Pulmonary Medicine, Division of Medicine, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Dag Berild
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Infectious Disease, Oslo University Hospital, 0424 Oslo, Norway
| | - Are Martin Holm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Respiratory Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, 7804 Bergen, Norway
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Jabbour JP, Ciotti G, Maestrini G, Brescini M, Lisi C, Ielo C, La Pietra G, Luise C, Riemma C, Breccia M, Brunetti GA, Carmosino I, Latagliata R, Morano GS, Martelli M, Girmenia C. Utility of procalcitonin and C-reactive protein as predictors of Gram-negative bacteremia in febrile hematological outpatients. Support Care Cancer 2022; 30:4303-4314. [PMID: 35088150 DOI: 10.1007/s00520-021-06782-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
This study was designed to determine the utility of procalcitonin (PCT) and C-reactive protein (CRP) as predictors of Gram-negative bloodstream infection (GN-BSI) in hematological febrile outpatients at the time of the emergency unit admission. Overall, 286 febrile episodes, which included 42 GN-BSI (16%), were considered. PCT levels at patient admission were statistically higher in GNB-BSI when compared to Gram-positive bacteria BSI (median 4.06 ng/ml (range 1.10-25.04) vs 0.88 ng/ml (0.42-10), p<0.03) and to all other fever etiologies. For CRP, differences within fever etiologies were less profound but statistically significant, except for GN-BSIs vs GP BSIs (p=0.4). ROC analysis of PCT showed that an AUC of 0.85 (95%CI 0.79-0.95) discriminated GN-BSI from all other fever etiologies, with a best cut-off of 0.5 ng/ml, a negative predictive value (NPV) of 98%, and a negative likelihood ratio (negLR) of 0.1. ROC analysis of CRP showed an AUC of 0.67 (95%CI 0.53-0.81) with a best cut-off of 6.64 mg/dl, a NPV of 94%, and a negLR of 0.33. This study confirms that 0.5 ng/ml represents the PCT best cut-off to differentiate the cause of fever and rule out a GN-BSI in febrile hematologic outpatients at the time of the emergency unit admission. Therefore, introducing PCT testing could be a valid measure in order to tailor a more precise prompt antimicrobial therapy to the febrile outpatient while waiting for blood culture results.
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Affiliation(s)
- Jean Pierre Jabbour
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Giulia Ciotti
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Giacomo Maestrini
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Mattia Brescini
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Chiara Lisi
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Claudia Ielo
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Gianfranco La Pietra
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Cristina Luise
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Costantino Riemma
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Massimo Breccia
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Gregorio Antonio Brunetti
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Ida Carmosino
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Roberto Latagliata
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Giacomo Salvatore Morano
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Maurizio Martelli
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Corrado Girmenia
- UOSD Pronto Soccorso e Accettazione Ematologica, Department of Hematology, AOU Policlinico Umberto I, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy.
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Boussi LS, Popli T, Feola N, Nog R. Clinical and microbiological characteristics of patients with bacteremia and normal procalcitonin. Diagn Microbiol Infect Dis 2021; 101:115515. [PMID: 34547664 DOI: 10.1016/j.diagmicrobio.2021.115515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
Procalcitonin is a biomarker of bacterial infection used to guide antimicrobial therapy. However, emerging studies have highlighted bacteremic patients with low procalcitonin, potentially limiting its clinical utility. Here, we conducted an observational, retrospective study analyzing clinical and microbiological parameters of adult patients with bacteremia and procalcitonin <2 ng/mL. High proportions of patients required intensive care (31.2%) with vasopressor (14.9%) or ventilatory (17.7%) support, developed renal injury (30.7%), or had in-hospital mortality (14.4%). When divided into subgroups by procalcitonin level, patients with procalcitonin 0.5 to 2.0 ng/mL had significantly higher rates of in-hospital mortality, vasopressor requirement, and renal injury than those with procalcitonin <0.5 ng/mL. Altogether, bacteremic patients had significant morbidity and mortality despite low procalcitonin. While subgroup analysis suggested that higher procalcitonin may correlate with illness severity, a more sensitive procalcitonin cutoff did not eliminate patients with significant disease. Procalcitonin-based algorithms may not be clinically appropriate for management of bacteremia.
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Affiliation(s)
- Leora S Boussi
- Section of Infectious Diseases, Department of Internal Medicine, Westchester Medical Center, Westchester, NY, USA.
| | - Tarun Popli
- Section of Infectious Diseases, Department of Internal Medicine, Westchester Medical Center, Westchester, NY, USA
| | - Nicholas Feola
- Section of Infectious Diseases, Department of Internal Medicine, Westchester Medical Center, Westchester, NY, USA
| | - Rajat Nog
- Section of Infectious Diseases, Department of Internal Medicine, Westchester Medical Center, Westchester, NY, USA
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Agnello L, Bivona G, Parisi E, Lucido GD, Iacona A, Ciaccio AM, Giglio RV, Ziino O, Ciaccio M. Presepsin and Midregional Proadrenomedullin in Pediatric Oncologic Patients with Febrile Neutropenia. Lab Med 2021; 51:585-591. [PMID: 32221546 DOI: 10.1093/labmed/lmaa011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE In this study, we investigated the roles of presepsin (PSP) and midregional proadrenomedullin (mr-proADM) in children with febrile neutropenia (FN) due to chemotherapy. METHODS We assessed 36 FN episodes in 26 children. Patients were classified into bacteremia (B) and fever of unknown origin (FUO) groups. We evaluated PSP and mr-proADM at admission (T0), after 24/48 h (T1), and after 5 days (T2). RESULTS PSP and mr-proADM levels were elevated at T0 and significantly decreased at T2. mr-proADM levels did not significantly differ between the B and FUO groups. PSP levels significantly differed between the B and FUO groups only at T1. Both PSP and mr-proADM levels at T0 were a predictor of length of hospital stay but not of the duration of fever. Finally, receiver operating characteristic curve analysis showed that PSP and mr-proADM had low diagnostic accuracy for blood culture positivity. CONCLUSION PSP and mr-proADM display poor clinical usefulness for FN in oncologic children.
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Affiliation(s)
- Luisa Agnello
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Palermo, Italy
| | - Giulia Bivona
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Palermo, Italy
| | - Elisa Parisi
- Pediatric Hematology and Oncology, ARNAS Civico Hospital, Palermo, Italy
| | | | | | | | | | - Ottavio Ziino
- Pediatric Hematology and Oncology, ARNAS Civico Hospital, Palermo, Italy
| | - Marcello Ciaccio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Palermo, Italy.,Department of Laboratory Medicine, Palermo, Italy
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8
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Smith SE, Muir J, Kalabalik-Hoganson J. Procalcitonin in special patient populations: Guidance for antimicrobial therapy. Am J Health Syst Pharm 2021; 77:745-758. [PMID: 32340027 DOI: 10.1093/ajhp/zxaa089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Procalcitonin (PCT) is an endogenous hormone that increases reliably in response to bacterial infection, and measurement of serum PCT levels is recommended to help guide antimicrobial therapy. The utility of PCT assessment in special patient populations (eg, patients with renal dysfunction, cardiac compromise, or immunocompromised states and those undergoing acute care surgery) is less clear. The evidence for PCT-guided antimicrobial therapy in special populations is reviewed. SUMMARY In the presence of bacterial infection, nonneuroendocrine PCT is produced in response to bacterial toxins and inflammatory cytokines, resulting in markedly elevated levels of serum PCT. Cytokine induction in nonbacterial inflammatory processes activated by acute care surgery may alter the interpretation of PCT levels. The reliability of PCT assessment has also been questioned in patients with renal dysfunction, cardiac compromise, or immunosuppression. In many special populations, serum PCT may be elevated at baseline and increase further in the presence of infection; thus, higher thresholds for diagnosing infection or de-escalating therapy should be considered, although the optimal threshold to use in a specific population is unclear. Procalcitonin-guided antimicrobial therapy may be recommended in certain clinical situations. CONCLUSION Procalcitonin may be a reliable marker of infection even in special populations with baseline elevations in serum PCT. However, due to unclear threshold values and the limited inclusion of special populations in relevant clinical trials, PCT levels should be considered along with clinical criteria, and antibiotics should never be initiated or withheld based on PCT values alone. Procalcitonin measurement may have a role in guiding de-escalation of antibiotic therapy in special populations; however, the clinician should be aware of disease states and concomitant therapies that may affect interpretation of results.
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Affiliation(s)
- Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA
| | - Justin Muir
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
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Diagnostic Accuracy of Procalcitonin, Neutrophil-to-Lymphocyte Ratio, and C-Reactive Protein in Detection of Bacterial Infections and Prediction of Outcome in Nonneutropenic Febrile Patients with Lung Malignancy. JOURNAL OF ONCOLOGY 2020; 2020:2192378. [PMID: 32908505 PMCID: PMC7468665 DOI: 10.1155/2020/2192378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/15/2020] [Accepted: 08/08/2020] [Indexed: 12/17/2022]
Abstract
Background Procalcitonin (PCT), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) have emerged as important markers of inflammation, and these markers, especially PCT and CRP, have been studied in patients with neutropenia. This study was designed to evaluate their value in differentiating infectious fever from tumor fever (TF) and to investigate their role in assessing outcomes in nonneutropenic lung cancer patients (NNLCPs). Methods This retrospective clinical study included 588 febrile NNLCPs between January 2019 and December 2019. The levels of PCT, CRP, and conventional inflammatory markers, including white blood cells (WBC) and neutrophils (NEU), were measured. NLR was defined as the ratio of the absolute neutrophil count to the absolute lymphocyte count. Patients' clinical and bacteriological data were recorded. Results This study included 311 NNLCPs with bacterial infections and 277 with TF. Inflammatory markers such as PCT, CRP, WBC, and NEU levels and NLR were significantly higher in patients with bacterial infections than in those with TF (p < 0.0001). However, PCT level was the best predictor of bacterial infections, with an area under the curve (AUC) of 0.874, followed by CRP level (AUC = 0.855) and NLR (AUC = 0.792) (p < 0.0001). Additionally, PCT level was significantly elevated in patients with bacterial infections with progressive disease after radiotherapy and chemotherapy (p < 0.01). Conclusions The present study demonstrated the superiority of PCT over CRP and NLR in the diagnosis of febrile patients with bacterial infections. Additionally, PCT can be used to assess the clinical outcomes and cancer progression in NNLCPs.
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Sütcüoğlu O, Akdoğan O, İnci BK, Gürler F, Özdemir N, Yazıcı O. Effect of serum uric acid level and Multinational Association for Supportive Care in Cancer risk score on febrile neutropenia mortality. Support Care Cancer 2020; 29:1047-1053. [PMID: 32583058 DOI: 10.1007/s00520-020-05587-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The study was aimed to evaluate the effect of uric acid (UA) on the 30-day mortality of patients admitted to the tertiary referral hospital with a complaint of febrile neutropenia (FEN). The secondary aim was to evaluate the use of combining serum UA levels with the Multinational Association for Supportive Care in Cancer (MASCC) risk score. METHODS A retrospective study in which the MASCC score and serum UA levels were used to evaluate the mortality risk within 30 days among patients with FEN. RESULTS A total of 118 FEN episodes were included in the study and 17 (14%) of these patients died. While this rate is 23% in the high-risk group according to the MASCC score, it is 7% in the low-risk group (p = 0.011). In multivariate analysis of the parameters that significantly affect the 30-day FEN mortality, MASCC risk score (OR, 4.28; CI 95% 1.19-15.39, p = 0.013) and having a level of serum UA > 7 mg/dL (OR, 4.46; CI 95% 1.19-15.38, p = 0.032) was significantly increased the risk of in 30-day mortality of FEN. The rate of 30-day mortality of FEN was 0% in patients with a low MASCC risk score and UA level compared with 50% in the high MASCC risk score and high UA level group, and the difference was statistically significant (p < 0.001). CONCLUSION Increased level of UA at the time of FEN diagnosis was independently associated with an increased rate of 30-day mortality of FEN. The combination of the MASCC risk score and serum UA level might thoroughly predict the 30-day mortality of FEN.
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Affiliation(s)
- Osman Sütcüoğlu
- Department of Medical Oncology, Gazi University, Ankara, Turkey.
| | - Orhun Akdoğan
- Department of Internal Medicine, Gazi University, Ankara, Turkey
| | - Bediz Kurt İnci
- Department of Medical Oncology, Gazi University, Ankara, Turkey
| | - Fatih Gürler
- Department of Medical Oncology, Gazi University, Ankara, Turkey
| | - Nuriye Özdemir
- Department of Medical Oncology, Gazi University, Ankara, Turkey
| | - Ozan Yazıcı
- Department of Medical Oncology, Gazi University, Ankara, Turkey
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Yang M, Choi SJ, Lee J, Lee DG, Kim YJ, Park YJ, Oh EJ. Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies. PLoS One 2019; 14:e0225765. [PMID: 31821331 PMCID: PMC6903763 DOI: 10.1371/journal.pone.0225765] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background Serum procalcitonin (PCT) and C-reactive protein (CRP) are biomarkers of infection. In patients with hematologic disorders with or without hematopoietic stem cell transplantation (HSCT), it is difficult to distinguish bloodstream infections from aseptic causes of febrile episodes. The objective of this study was to investigate diagnostic values of PCT and CRP in predicting systemic bacterial infection in patients with hematologic malignancies. Methods Clinical and laboratory data of 614 febrile episode cases from 511 patients were analyzed. Febrile episodes were classified into four groups: (1) culture-positive bacterial infection by Gram-positive cocci (GPC), (2) culture-positive bacterial infection by Gram-negative bacilli (GNB), (3) fungal infection, and (4) viral infection or a noninfectious etiology. Results Of 614 febrile cases, systemic bacterial infections were confirmed in 99 (16.1%) febrile episodes, including 38 (6.2%) GPC and 61 (9.9%) GNB infections. PCT levels were significantly higher in GNB infectious episodes than those in febrile episodes caused by fungal infection (0.58 ng/mL (95% CI: 0.26–1.61) vs. 0.22 ng/mL (0.16–0.38), P = 0.047). Bacterial infectious episodes showed higher PCT and CRP levels than non-bacterial events (PCT: 0.49 (0.26–0.93) ng/mL vs. 0.20 (0.18–0.22) ng/mL, P < 0.001; CRP: 76.6 (50.5–92.8) mg/L vs. 58.0 (51.1–66.5) mg/L, P = 0.036). For non-neutropenic febrile episodes, both PCT and CRP discriminated bacteremia from non-bacteremia. However, in neutropenic febrile episodes, PCT only distinguished bacteremia from non-bacteremia. In non-neutropenic episode, both PCT and CRP showed good diagnostic accuracy (AUC: 0.757 vs. 0.763). In febrile neutropenia, only PCT discriminated bacteremia from non-bacterial infection (AUC: 0.624) whereas CRP could not detect bacteremia (AUC: 0.500, 95% CI: 0.439–0.561, P > 0.05). Conclusions In this single-center observational study, PCT was more valuable than CRP for discriminating between bacteremia and non-bacteremia independent of neutropenia or HSCT.
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Affiliation(s)
- Mina Yang
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seung Jun Choi
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewoong Lee
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Gun Lee
- Department of Internal Medicine, Division of infection, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Yeon-Joon Park
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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Comparison of the Power of Procalcitonin and C-Reactive Protein to Discriminate between Different Aetiologies of Fever in Prolonged Profound Neutropenia: A Single-Centre Prospective Observational Study. Mediterr J Hematol Infect Dis 2019; 11:e2019023. [PMID: 30858961 PMCID: PMC6402549 DOI: 10.4084/mjhid.2019.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/01/2019] [Indexed: 01/03/2023] Open
Abstract
Management of fever in prolonged, profound neutropenia remains challenging with many possible infectious and non-infectious causes. We investigated whether procalcitonin (PCT) is superior to C-reactive protein (CRP) in discriminating between different aetiologies of fever in this setting. CRP and PCT were tested daily during 93 neutropenic episodes in 66 patients. During this study period, 121 febrile episodes occurred and were classified into four categories based on clinical and microbiological findings: microbiologically documented infection (MDI); clinically documented infection (CDI); proven or probable invasive fungal disease (IFD); fever of unknown origin (FUO). Values of PCT and CRP at fever onset as well as two days later were considered for analysis of their performance in distinguishing aetiologies of fever. At fever onset, no significant difference in PCT values was observed between different aetiologies of fever, whereas median CRP values were significantly higher in case of IFD (median 98.8 mg/L vs 28.8 mg/L, p=0.027). Both PCT and CRP reached their peak at a median of 2 days after fever onset. Median PCT values on day 2 showed no significant difference between the aetiologies of fever. Median CRP values on day 2 were significantly higher in IFD (median 172 mg/L versus 78.4 mg/L, p=0.002). In MDI median CRP values rose > 100 mg/L, whereas they did not in CDI or FUO. PCT has no added value over CRP for clinical management of fever in prolonged, profound neutropenia. When performing reassessment 2 days after fever onset, CRP has better discriminatory power between aetiologies of fever.
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Trippella G, Galli L, De Martino M, Lisi C, Chiappini E. Procalcitonin performance in detecting serious and invasive bacterial infections in children with fever without apparent source: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2017; 15:1041-1057. [DOI: 10.1080/14787210.2017.1400907] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Giulia Trippella
- Post-graduate School of Pediatrics, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Luisa Galli
- Division of Pediatric Infectious Disease, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Catiuscia Lisi
- Department of Statistics, University of Florence, Florence, Italy
| | - Elena Chiappini
- Division of Pediatric Infectious Disease, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
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Mazo C, Borgatta B, Pont T, Sandiumenge A, Moyano S, Roman A, Rello J. Procalcitonin accurately predicts lung transplant adults with low risk of pulmonary graft dysfunction and intensive care mortality. J Crit Care 2017; 44:142-147. [PMID: 29112904 DOI: 10.1016/j.jcrc.2017.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We evaluated the association of procalcitonin (PCT), IL-6-8-10 plasma levels during the first 72h after lung transplantation (LT) with ICU-mortality, oxygenation, primary graft dysfunction (PGD), and one-year graft function after LT. MATERIAL AND METHODS Prospective, observational study. PCT and IL-6-8-10 plasma levels were measured at 24h, 48h and 72h after LT from 100 lung transplant recipients (LTr). Patients were followed until one year after LT. End-points were ICU survival, grade 3 PGD at 72h and one-year graft function. RESULTS Higher PCT at 24h was associated with lower PaO2/FIO2 ratio and Grade 3 PGD over the first 72h after LT (p<0.05). PCT at 24h was higher in the 9 patients who died (2.90 vs 1.47ng/mL, p<0.05), with AUC=0.74 for predicting ICU-mortality. All patients with PCT<2ng/mL at 24h following LT, survived in the ICU (p<0.05). PCT and IL-10 at 48h were correlated with FEV1 (rho=-0.35) and FVC (rho=-0.29) one year after LT. (p<0.05). CONCLUSIONS A breakpoint of PCT<2ng/mL within 24h has a high predictive value to exclude grade 3 PGD at 72h and for ICU survival. Moreover, both PCT and IL-10 within 48h were associated with significantly better graft function one year after surgery.
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Affiliation(s)
- Cristopher Mazo
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Bárbara Borgatta
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Teresa Pont
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Alberto Sandiumenge
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Silvia Moyano
- Vall d'Hebron Institut de Recerca, Barcelona, Spain.
| | - Antonio Roman
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Pulmonary Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Jordi Rello
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
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Bruno B, Busca A, Vallero S, Raviolo S, Mordini N, Nassi L, Cignetti A, Audisio E, Festuccia M, Corsetti A, Depaoli L, Faraci M, Micalizzi C, Corcione S, Berger M, Saglio F, Caropreso P, Mengozzi G, Squadrone V, De Rosa FG, Giaccone L. Current use and potential role of procalcitonin in the diagnostic work up and follow up of febrile neutropenia in hematological patients. Expert Rev Hematol 2017; 10:543-550. [PMID: 28471695 DOI: 10.1080/17474086.2017.1326813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Febrile neutropenia (FN) represents a life-threatening complication in hematological malignancies. Its etiology is most often due to infections even though FN of other origins, such as tumor-related fever and non-infectious inflammation, should rapidly be ruled out. Initially, C-reactive protein and, more recently, procalcitonin (PCT) have been proposed as useful biomarkers for differential diagnosis. PCT was shown to be a good biomarker of bacterial infections and their clinical outcomes. Definition of standard cut-offs and design of PCT-guided treatment protocols remain however to be defined. Areas covered: In this review, highlights on the current clinical use of PCT and its potential role as a diagnostic tool have been discussed by a panel of physicians from different areas of expertise. We provide current clinical evidence that PCT has been shown to be a reliable biomarker to differentiate fever of bacterial origin from other causes. Moreover, the Authors convened to a round-table to discuss their 'real-life experience' and offer their recommendations by a Delphi survey. Expert commentary: PCT has an important clinical role in FN. Issues such as the validation of a specific decision algorithm that includes PCT to monitor antibiotic choice and treatment duration will be addressed in prospective studies.
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Affiliation(s)
- Benedetto Bruno
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy.,b Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Alessandro Busca
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Stefano Vallero
- c Pediatric Oncology and Hematology , OIRM, A.O.U. Città della Salute e della Scienza di Torino , Torino , Italy
| | - Stefania Raviolo
- d Department of Clinical Sciences , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Nicola Mordini
- e Hematology , S, Croce e Carle Hospital , Cuneo , Italy
| | - Luca Nassi
- f Hematology , AOU Maggiore della Carità and University of Eastern Piedmont , Novara , Italy
| | | | - Ernesta Audisio
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Moreno Festuccia
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy.,b Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | | | - Lorella Depaoli
- h Hematology , SS Antonio e Biagio Hospital , Alessandria , Italy
| | - Maura Faraci
- i Department of Hematology-Oncology , Istituto G. Gaslini , Genova , Italy
| | - Concetta Micalizzi
- j Department of Clinical Chemistry , SC Baldi e Riberi, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Silvia Corcione
- d Department of Clinical Sciences , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Massimo Berger
- c Pediatric Oncology and Hematology , OIRM, A.O.U. Città della Salute e della Scienza di Torino , Torino , Italy
| | - Francesco Saglio
- c Pediatric Oncology and Hematology , OIRM, A.O.U. Città della Salute e della Scienza di Torino , Torino , Italy
| | - Paola Caropreso
- j Department of Clinical Chemistry , SC Baldi e Riberi, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Giulio Mengozzi
- j Department of Clinical Chemistry , SC Baldi e Riberi, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | - Vincenzo Squadrone
- k Department of Intensive Care and Critical Care , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy
| | | | - Luisa Giaccone
- a Department of Oncology , A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette , Torino , Italy.,b Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
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Abstract
PURPOSE OF REVIEW Neutropenic fever is the most common infective complication in patients receiving cytotoxic chemotherapy, and may result in severe sepsis, septic shock and mortality. Advancements in approaches to empiric antimicrobial therapy and prophylaxis have resulted in improved outcomes. Mortality may, however, still be as high as 50% in high-risk cancer populations. The objective of this review is to summarize factors associated with reduced mortality in patients with neutropenic fever, highlighting components of clinical care with potential for inclusion in quality improvement programs. RECENT FINDINGS Risks for mortality are multifactorial, and include patient, disease and treatment-related factors. Historically, guidelines for management of neutropenic fever have focused upon antimicrobial therapy. There is, however, a recognized need for early identification of sepsis to enable timely administration of antibiotic therapy and for this to be integrated with a whole of systems approach within healthcare facilities. Use of Systemic Inflammatory Response Syndrome criteria is beneficial, but validation is required in neutropenic fever populations. SUMMARY In the context of emerging and increasing infections because of antimicrobial-resistant bacteria in patients with neutropenic fever, quality improvement initiatives to reduce mortality must encompass antimicrobial stewardship, early detection of sepsis, and use of valid tools for clinical assessment. C-reactive protein and procalcitonin hold potential for inclusion into clinical pathways for management of neutropenic fever.
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Sahin U, Toprak SK, Atilla PA, Atilla E, Demirer T. An overview of infectious complications after allogeneic hematopoietic stem cell transplantation. J Infect Chemother 2016; 22:505-14. [PMID: 27344206 DOI: 10.1016/j.jiac.2016.05.006] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/05/2016] [Accepted: 05/20/2016] [Indexed: 12/31/2022]
Abstract
Infections are the most common and significant cause of mortality and morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The presence of neutropenia and mucosal damage are the leading risk factors in the early pre-engraftment phase. In the early post-engraftment phase, graft versus host disease (GvHD) induced infection risk is increased in addition to catheter related infections. In the late phase, in which reconstitution of cellular and humoral immunity continues, as well as the pathogens seen during the early post-engraftment phase, varicella-zoster virus and encapsulated bacterial infections due to impaired opsonization are observed. An appropriate vaccination schedule following the cessation of immunosuppressive treatment after transplantation, intravenous immunoglobulin administration, and antimicrobial prophylaxis with penicillin or macrolide antibiotics during immunosuppressive treatment for GvHD might decrease the risk of bacterial infections. Older age, severe mucositis due to toxicity of chemotherapy, gastrointestinal tract colonization, prolonged neutropenia, unrelated donor and cord blood originated transplantations, acute and chronic GvHD are among the most indicative clinical risk factors for invasive fungal infections. Mold-active anti-fungal prophylaxis is suggested regardless of the period of transplantation among high risk patients. The novel serological methods, including Aspergillus galactomannan antigen and beta-D-glucan detection and computed tomography are useful in surveillance. Infections due to adenovirus, influenza and respiratory syncytial virus are encountered in all phases after allo-HSCT, including pre-engraftment, early post-engraftment and late phases. Infections due to herpes simplex virus-1 and -2 are mostly seen during the pre-engraftment phase, whereas, infections due to cytomegalovirus and human herpes virus-6 are seen in the early post-engraftment phase and Epstein-Barr virus and varicella-zoster virus infections often after +100th day. In order to prevent mortality and morbidity of infections after allo-HSCT, the recipients should be carefully followed-up with appropriate prophylactic measures in the post-transplant period.
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Affiliation(s)
- Ugur Sahin
- Ankara University Medical School, Department of Hematology, Ankara, Turkey
| | | | - Pinar Ataca Atilla
- Ankara University Medical School, Department of Hematology, Ankara, Turkey
| | - Erden Atilla
- Ankara University Medical School, Department of Hematology, Ankara, Turkey
| | - Taner Demirer
- Ankara University Medical School, Department of Hematology, Ankara, Turkey.
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Liu HH, Zhang MW, Guo JB, Li J, Su L. Procalcitonin and C-reactive protein in early diagnosis of sepsis caused by either Gram-negative or Gram-positive bacteria. Ir J Med Sci 2016; 186:207-212. [DOI: 10.1007/s11845-016-1457-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/11/2016] [Indexed: 12/11/2022]
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Işlak Mutcalı S, Saltoğlu N, Balkan İİ, Özaras R, Yemişen M, Tabak F, Mert A, Öztürk R, Öngören Ş, Başlar Z, Aydın Y, Ferhanoğlu B, Soysal T. Early Changes of Mannose-Binding Lectin, H-Ficolin, and Procalcitonin in Patients with Febrile Neutropenia: A Prospective Observational Study. Turk J Haematol 2015; 33:304-310. [PMID: 26377840 PMCID: PMC5204185 DOI: 10.4274/tjh.2014.0385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The significance of mannose-binding lectin (MBL) and H-ficolin deficiency in febrile neutropenic (FN) patients and the correlation of these markers along with consecutive C-reactive protein (CRP) and procalcitonin (PCT) levels during the infectious process are investigated. Materials and Methods: Patients with any hematological malignancies who were defined to have “microbiologically confirmed infection”, “clinically documented infection”, or “fever of unknown origin” were included in this single-center prospective observational study. Serum levels of CRP, PCT, MBL, and H-ficolin were determined on 3 separate occasions: at baseline (between hospital admission and chemotherapy), at the onset of fever, and at the 72nd hour of fever. Results: Forty-six patients (54% male, mean age 41.7 years) with 61 separate episodes of FN were evaluated. Eleven patients (23.9%) had “microbiologically confirmed infection”, 17 (37%) had “clinically documented infection”, and 18 (39.1%) had “fever of unknown origin”. Fourteen (30.4%) patients had low (<500 ng/mL) initial MBL levels and 7 (15.21%) had low (<12,000 ng/mL) H-ficolin levels. Baseline MBL and H-ficolin levels did not significantly change on the first and third days of fever (p=0.076). Gram-negative bacteremia more frequently occurred in those with low initial MBL levels (p=0.006). PCT levels were significantly higher in those with microbiologically documented infections. Mean and median PCT levels were significantly higher in cases with bacteremia. There was no significant difference between hemoculture-positive and-negative patients in terms of CRP levels. Conclusion: Monitoring serum H-ficolin levels was shown to be of no benefit in terms of predicting severe infection. Low baseline MBL levels were correlated with high risk of gram-negative bacteremia; however, no significant correlation was shown in the follow-up. Close monitoring of PCT levels is warranted to provide more accurate and specific data while monitoring cases of bacteremia.
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Affiliation(s)
| | | | - İlker İnanç Balkan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey, Phone: +90 212 414 30 00, E-mail:
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Serum procalcitonin levels in patients with primary pulmonary coccidioidomycosis. Ann Am Thorac Soc 2015; 11:1239-43. [PMID: 25168059 DOI: 10.1513/annalsats.201404-180bc] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The serum procalcitonin assay has emerged as a promising biomarker to distinguish between bacterial and viral respiratory tract infections but has not been used to differentiate coccidioidomycosis from bacterial infection. A correlation between procalcitonin serum levels and coccidioidomycosis has never been reported. OBJECTIVE To determine any association between serum procalcitonin levels and primary pulmonary coccidioidomycosis. METHODS We identified and enrolled 20 immunocompetent patients with symptomatic primary pulmonary coccidioidomycosis of < 8 weeks' duration and performed a one-time procalcitonin assay, with a cutoff of < 0.25 μg/L indicating a nonbacterial infection. MEASUREMENTS AND MAIN RESULTS Nineteen of 20 patients (95%) had serum procalcitonin of < 0.25 μg/L. The median procalcitonin level was 0.05 μg/L (range, < 0.05-0.87 μg/L; interquartile range, 0.05-0.05 μg/L). Sixteen of 20 patients (80%) had undetectable procalcitonin of < 0.05 μg/L. The four patients with detectable procalcitonin had a median value of 0.2 μg/L (range, 0.09-0.87 μg/L). CONCLUSIONS In this pilot study, procalcitonin was not elevated in immunocompetent patients with primary pulmonary coccidioidomycosis at a median of 32 days after symptom onset. Larger prospective studies are needed to confirm this finding.
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Kiszewska N, Bień E, Irga-Jaworska N, Adamkiewicz-Drożyńska E. Selected inflammatory markers in the diagnosis and monitoring of infections in children treated for hematological malignancies. Biomark Med 2015; 9:461-71. [DOI: 10.2217/bmm.14.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Infections in children treated for hematological malignancies pose a direct threat to life and are one of the most common causes of treatment failure in this group of patients. Unequivocal diagnosis at the early stages of infection together with an appropriate and timely treatment may be often difficult due to poor manifestation and nonspecific clinical symptoms of the infection progress. Inflammatory markers make a useful diagnostic tool for this purpose. They significantly help to diagnose, monitor, stratify and predict the outcome in severe infections. This article describes selected biomarkers, both those commonly used in clinical practice, such as erythrocyte sedimentation rate, C-reactive protein, procalcitonin as well as less common like IL-6, IL-8 and moreover one promising novel marker – pentraxin 3. The authors emphasize their diagnostic value, clinical usefulness and significance in the treatment efficacy monitoring.
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Affiliation(s)
- Natalia Kiszewska
- Department of Paediatrics, Haematology & Oncology, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Ewa Bień
- Department of Paediatrics, Haematology & Oncology, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Ninela Irga-Jaworska
- Department of Paediatrics, Haematology & Oncology, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
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Lenski M, Scherer MA. Diagnostic potential of inflammatory markers in septic arthritis and periprosthetic joint infections: a clinical study with 719 patients. Infect Dis (Lond) 2015; 47:399-409. [DOI: 10.3109/00365548.2015.1006674] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Oksuz L, Somer A, Salman N, Erk O, Gurler N. Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia. Braz J Microbiol 2015; 45:1415-21. [PMID: 25763049 PMCID: PMC4323318 DOI: 10.1590/s1517-83822014000400036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 04/17/2014] [Indexed: 01/09/2023] Open
Abstract
Procalcitonin (PCT) and C-reactive protein (CRP) are important biological markers used in the diagnosis of severe infections. The aim of this study was to evaluate the consistency of blood culture with PCT and CRP in differentiating contamination and non-bacteremia from true bacteremia. In this study blood samples were obtained from 809 febrile patients and analyzed using BACTEC 9120 system. All of positive blood cultures were performed Gram staining. The microorganisms were identified with conventional methods and automated systems. Antibiotic susceptibility tests were made by disc diffusion. PCT levels were analyzed by mini VIDAS device and PCT kit. PCT and CRP levels were analyzed with blood cultures in same times. Kruskal Wallis test, Mann-Whitney U test, Spearman’s rho test and ROC curve were used for statistical analyses. The bacteremia group was found to be significantly different from non-bacteremia group and contamination group in terms of both PCT and CRP (p<0.0001). The p values of PCT and CRP in differentiating bacteremia from non-bacteremia were p<0.001 for PCT, p=0.002 for CRP and in differentiating bacteremia from contamination were p<0.001 for PCT, p<0.001 for CRP. PCT is a more useful marker than CRP in the differentiating of true bacteremia from contamination according to the results of this study.
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Affiliation(s)
- Lutfiye Oksuz
- Istanbul Faculty of Medicine Department of Medical Microbiology Istanbul Turkey Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Ayper Somer
- Istanbul Faculty of Medicine Department of Pediatric Infectious Diseases Istanbul Turkey Istanbul Faculty of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Nuran Salman
- Istanbul Faculty of Medicine Department of Pediatric Infectious Diseases Istanbul Turkey Istanbul Faculty of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Osman Erk
- Istanbul Faculty of Medicine Department of Emergency Internal Medicine Istanbul Turkey Istanbul Faculty of Medicine, Department of Emergency Internal Medicine, Istanbul, Turkey
| | - Nezahat Gurler
- Istanbul Faculty of Medicine Department of Medical Microbiology Istanbul Turkey Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
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Desmard M, Benbara A, Boudinet S, Mal H, Dehoux M, Thabut G, Montravers P. Post-operative kinetics of procalcitonin after lung transplantation. J Heart Lung Transplant 2015; 34:189-94. [DOI: 10.1016/j.healun.2014.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 09/03/2014] [Accepted: 09/18/2014] [Indexed: 11/29/2022] Open
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Sánchez-Yepes M, Aznar-Oroval E, Lorente-Alegre P, García-Lozano T, Picón-Roig I, Pérez-Ballestero P, Ortiz-Muñoz B. Utilización de procalcitonina y proteína C reactiva como marcadores de infección en la neutropenia febril de pacientes sometidos a trasplante de progenitores hematopoyéticos. Enferm Infecc Microbiol Clin 2014; 32:418-23. [DOI: 10.1016/j.eimc.2013.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 08/30/2013] [Accepted: 09/05/2013] [Indexed: 11/17/2022]
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Karakurt DG, Demirsoy U, Corapcioglu F, Oncel S, Karadogan M, Arisoy ES. Do proinflammatory cytokine levels predict serious complication risk of infection in pediatric cancer patients? Pediatr Hematol Oncol 2014; 31:415-24. [PMID: 24499434 DOI: 10.3109/08880018.2013.848387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Determination of risk of severe bacterial infection complication in children with cancer is important to diminish the cost of hospitalization and therapy. In this study, children with cancer (leukemia excluded) were evaluated for risk of severe infection complication, success of therapy and the relation between clinical and inflammatory parameters during neutropenic fever attacks. Children who fulfilled the criteria of neutropenic fever with cancer were enrolled in the study. During admission, together with clinical and laboratory parameters; interleukin-6, interleukin-8, soluble tumor necrosis factor receptor II, and soluble interleukin 2 reseptor ve procalcitonin levels were detected. Empirical therapy was started with piperacillin/tazobactam and relation between the inflammatory cytokine levels and therapy response parameters were evaluated. The study population included 31 children and 50 neutropenic attacks were studied. In 48% of the attacks, absolute neutrophile count was >100/mm(3) and infectious agents were shown microbiologically in 12% of the attacks. In the study group with piperacillin/tazobactam monotherapy, the success rate without modification was 58%. In the therapy modified group mean duration of fever, antibiotherapy and hospitalization were significantly longer than the group without modification. Inflammatory cytokines' levels during admission (interleukin-6, interleukin-8, soluble tumor necrosis factor reseptor II) were higher in patients with fever >3 days and in multiple regression analysis, it has been shown that they have a determinative role on fever control time. Other cytokines did not show any significant relationship with risk of severe bacterial infection complication and success of therapy.
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Aimoto M, Koh H, Katayama T, Okamura H, Yoshimura T, Koh S, Nanno S, Nishimoto M, Hirose A, Nakamae M, Nakane T, Nakamae H, Kakeya H, Hino M. Diagnostic performance of serum high-sensitivity procalcitonin and serum C-reactive protein tests for detecting bacterial infection in febrile neutropenia. Infection 2014; 42:971-9. [PMID: 25038889 DOI: 10.1007/s15010-014-0657-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 06/26/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE Although a few prospective studies have addressed the question as to which biomarker of infection in adult patients with febrile neutropenia (FN) is superior, procalcitonin (PCT) or C-reactive protein (CRP), the results have been inconsistent and inconclusive. This was possibly due to the poor sensitivity of previous PCT tests that have a functional sensitivity of 0.5 ng/ml. METHODS Between November 2010 and February 2012, we prospectively compared the diagnostic utility of serum high-sensitivity (hs) PCT (lower limit of detection, 0.02 ng/ml) and CRP levels for detecting bacterial infection in patients with FN. Serum was collected within 72 h after the onset of FN in patients with hematological disorders. RESULTS Seventy-five febrile episodes were evaluable. The areas under the receiver operating characteristic curves for life-threatening infection defined as septic shock and bacteremia caused by non-coagulase negative staphylococcus were 0.824 (95% CI 0.711-0.937; P = 0.001) for hsPCT and 0.673 (0.505-0.842; P = 0.068) for CRP, respectively. In contrast, CRP, but not hsPCT, tended to increase significantly with the clinical severity, as indicated by the diagnostic classification (P = 0.002 for trend). CONCLUSIONS The serum hsPCT test may be more useful than the serum CRP test in the detection of life-threatening infection at an early phase after the onset of FN. In contrast, the serum CRP test may be more useful in diagnosing the severity of infection. However, neither of these tests was able to differentiate the cause of FN with a low probability of fatal outcome.
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Affiliation(s)
- Mizuki Aimoto
- Hematology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Liu X, Wang DF, Fang Y, Ye WF, Liu S, Lou N. Initial procalcitonin level predicts infection and its outcome in patients with non-Hodgkin lymphoma with febrile neutropenia. Leuk Lymphoma 2014; 56:85-91. [PMID: 24707944 DOI: 10.3109/10428194.2014.911864] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We explored whether initially determined procalcitonin (PCT) levels could facilitate assessment of the risks of infection and death due to treatment failure in patients with non-Hodgkin lymphoma (NHL) with newly developed febrile neutropenia (FN). In the 212 examined episodes, the initial PCT value was markedly higher in patients with microbiologically documented infection (MDI) or clinically documented infection compared with patients with fevers of unknown origin (p < 0.001 for both). Patients with initial PCT values ≥ 0.50 ng/mL were at high risk of MDI (sensitivity 83.5%, specificity 77.2%). A significantly elevated PCT level was closely correlated with patient mortality (area under the curve [AUC] 0.864, 95% confidence interval [CI] 0.811-0.907, p < 0.001) and patients' admission to the intensive care unit (AUC 0.926, 95% CI 0.882-0.957, p < 0.001). In conclusion, the initially determined PCT value was a useful marker for identifying infection and predicting outcome in patients with NHL with FN.
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Affiliation(s)
- Xiao Liu
- Department of Critical Care Medicine, Sun Yat-sen University Cancer Center and State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
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Mikuła T, Suchacz M, Stańczak W, Kozłowska J, Wiercińska-Drapało A. Procalcitonin as a Biomarker of the Early Stage of Bacterial Infections in HIV/AIDS Patients. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We observed that low concentrations of procalcitonin (PCT) in the early stages of bacterial infection among HIV/AIDS patients are not always associated with a good prognosis. Many of our patients developed sepsis despite a PCT level of <0.5 ng/ml on the first days of infection. The aim of our study was to assess whether laboratory standards for PCT in patients with HIV/AIDS correlate with their clinical condition. We analyzed the concentration of PCT and other inflammatory markers in the early stages of bacterial infection among 40 HIV-infected patients and 52 AIDS patients enrolled for the study. The control group consisted of 37 healthy individuals. In comparison with PCT and WBC, PCT proved to be the most reliable in the early stages of bacterial infection. To conclude, we suggest new PCT cut-off ranges for HIV/AIDS patients with bacterial infection.
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Affiliation(s)
- T. Mikuła
- Department of Hepatology and Acquired Immunodeficiencies, Warsaw Medical University, Warsaw, Poland
| | - M. Suchacz
- Department of Hepatology and Acquired Immunodeficiencies, Warsaw Medical University, Warsaw, Poland
| | - W. Stańczak
- Department of Hepatology and Acquired Immunodeficiencies, Warsaw Medical University, Warsaw, Poland
| | - J. Kozłowska
- Department of Hepatology and Acquired Immunodeficiencies, Warsaw Medical University, Warsaw, Poland
| | - A. Wiercińska-Drapało
- Department of Hepatology and Acquired Immunodeficiencies, Warsaw Medical University, Warsaw, Poland
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Ahn S. Author’s response to ‘procalcitonin in febrile neutropenia—timing is important’. Support Care Cancer 2014; 22:585-6. [DOI: 10.1007/s00520-013-2109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/25/2013] [Indexed: 10/25/2022]
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Procalcitonin in febrile neutropenia—timing is important. Support Care Cancer 2013; 22:583-4. [DOI: 10.1007/s00520-013-2078-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/25/2013] [Indexed: 10/26/2022]
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Kitanovski L, Jazbec J, Hojker S, Derganc M. Diagnostic accuracy of lipopolysaccharide-binding protein for predicting bacteremia/clinical sepsis in children with febrile neutropenia: comparison with interleukin-6, procalcitonin, and C-reactive protein. Support Care Cancer 2013; 22:269-77. [PMID: 24057110 DOI: 10.1007/s00520-013-1978-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 09/11/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE In febrile neutropenia (FN), no reliable marker has been identified to discriminate between severe infection and other causes of fever early in the clinical course. Since lipopolysaccharide-binding protein (LBP) has proven to be an accurate biomarker of bacteremia/clinical sepsis in critically ill non-immunocompromised infants and children, we performed a prospective study to determine the diagnostic accuracy of LBP in children with FN. METHODS Concentrations of LBP, procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) were prospectively measured on two consecutive days in 90 FN episodes experienced by 47 children. Receiver operating characteristic curve analysis was performed for each biomarker to predict bacteremia/clinical sepsis and severe sepsis. RESULTS Eighteen of the 90 episodes were classified as bacteremia/clinical sepsis. On both days 1 and 2, all biomarkers had a low to intermediate diagnostic accuracy for sepsis, and no significant differences were found between them (area under the curve (AUC) for LBP, 0.648 and 0.714; for PCT, 0.665 and 0.744; for IL-6, 0.775 and 0.775; and for CRP, 0.695 and 0.828). Comparison of their AUCs to the AUC of maximum body temperature on admission (AUC = 0.668) also failed to show any significant differences. In severe sepsis, however, the best diagnostic accuracies were found for IL-6 and PCT (AUC 0.892 and 0.752, respectively), and these were significantly higher than those for LBP (AUC 0.566) on admission. CONCLUSIONS On admission and 24 h later, the LBP concentration is less accurate for predicting bacteremia/clinical sepsis compared to IL-6, PCT, and CRP.
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Affiliation(s)
- Lidija Kitanovski
- Division of Hemato-Oncology, Department of Pediatrics, University Medical Center Ljubljana, Ljubljana, Slovenia,
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Wróblewski T, Marcisz C. Procalcitonin as a biomarker of acute lower respiratory tract infections. ACTA ACUST UNITED AC 2013; 3:67-79. [PMID: 23495964 DOI: 10.1517/17530050802623859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Procalcitonin (PCT) has emerged as a promising 'acute phase' biomarker used for diagnosis of acute bacterial infections of the respiratory tract. The introduction of new sensitive PCT assays has facilitated implementation of a new clinical approach to reduce antibiotic use in acute lower respiratory tract infections (LRTIs), without compromising patient safety. OBJECTIVE Current state of knowledge on the clinical usefulness of serum PCT measurements for the evaluation of acute LRTIs is presented herein, together with basic information on available rapid diagnostic tests for PCT measurement. METHODS During the literature search the emphasis was on PCT use as a diagnostic, monitoring and prognostic tool for acute LRTIs. The acute LRTIs have been defined as acute bronchitis, acute exacerbations of chronic obstructive pulmonary disease or asthma, and pneumonia. Original studies involving patients with these conditions have been considered, and recent articles documenting interventional trials on PCT use for guidance of antimicrobial treatment in LRTIs have been reviewed in particular. RESULTS/CONCLUSION When measured with sensitive and rapid assays, PCT has proved to be a good biomarker for acute bacterial LRTIs, which enables an early diagnosis, facilitates therapeutic decisions, and can inform clinicians about the course of disease and prognosis. PCT can become a particularly suitable tool for implementation in an emergency and acute medical care setting.
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Affiliation(s)
- Tomasz Wróblewski
- Oddział Nefrologii i Chorób Wewnetrznych, Szpital Powiatowy w Chrzanowie, ul. Topolowa 16, PL 32-500 Chrzanów, Poland +48 32 624 7326, +48 32 624 7777 ; +48 32 623 9428 ;
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Sepsis in AIDS patients: clinical, etiological and inflammatory characteristics. J Int AIDS Soc 2013; 16:17344. [PMID: 23374857 PMCID: PMC3564973 DOI: 10.7448/ias.16.1.17344] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 09/29/2012] [Accepted: 01/08/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Intensive care mortality of HIV-positive patients has progressively decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. To better understand this condition, we propose a study comparing clinical, etiological and inflammatory data, and the hospital course of HIV-positive and HIV-negative patients with severe sepsis or septic shock. METHODS A prospective observational study enrolling patients with severe sepsis or septic shock associated or not with HIV infection, and admitted to intensive care unit (ICU). Clinical, microbiological and inflammatory parameters were assessed, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6, interleukin-10 and TNF-α. Outcome measures were in-hospital and six-month mortality. RESULTS The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV-negative. All HIV-positive patients met the criteria for AIDS (CDC/2008). The main foci of infection in HIV-positive patients were pulmonary and abdominal (p=0.001). Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4%) and Gram-positive cocci (36.4%) (p=0.001). CRP and PCT admission concentrations were lower in HIV-positive patients (130 vs. 168 mg/dL p=0.005, and 1.19 vs. 4.06 ng/mL p=0.04, respectively), with a progressive decrease in surviving patients. Initial IL-10 concentrations were higher in HIV-positive patients (4.4 pg/mL vs. 1.0 pg/mL, p=0.005), with moderate accuracy for predicting death (area under receiver-operating characteristic curve =0.74). In-hospital and six-month mortality were higher in HIV-positive patients (55.6 vs. 27.3% p=0.03, and 58.3 vs. 27.3% p=0.02, respectively). CONCLUSIONS The course of sepsis was more severe in HIV-positive patients, with distinct clinical, etiological and inflammatory characteristics.
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Abstract
Sepsis is among the most common causes of death in hospitals. It arises from the host response to infection. Currently, diagnosis relies on nonspecific physiological criteria and culture-based pathogen detection. This results in diagnostic uncertainty, therapeutic delays, the mis- and overuse of antibiotics, and the failure to identify patients who might benefit from immunomodulatory therapies. There is a need for new sepsis biomarkers that can aid in therapeutic decision making and add information about screening, diagnosis, risk stratification, and monitoring of the response to therapy. The host response involves hundreds of mediators and single molecules, many of which have been proposed as biomarkers. It is, however, unlikely that one single biomarker is able to satisfy all the needs and expectations for sepsis research and management. Among biomarkers that are measurable by assays approved for clinical use, procalcitonin (PCT) has shown some usefulness as an infection marker and for antibiotic stewardship. Other possible new approaches consist of molecular strategies to improve pathogen detection and molecular diagnostics and prognostics based on transcriptomic, proteomic, or metabolic profiling. Novel approaches to sepsis promise to transform sepsis from a physiologic syndrome into a group of distinct biochemical disorders and help in the development of better diagnostic tools and effective adjunctive sepsis therapies.
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Reitman AJ, Pisk RM, Gates JV, Ozeran JD. Serial procalcitonin levels to detect bacteremia in febrile neutropenia. Clin Pediatr (Phila) 2012; 51:1175-83. [PMID: 23034950 DOI: 10.1177/0009922812460913] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our objective was to evaluate serial procalcitonin (PCT) levels compared with an initial PCT level at admission in predicting bacteremia in pediatric febrile neutropenic oncology patients. PROCEDURE Serum PCT levels were measured at admission (t0) and within 24 hours of admission (t1) in pediatric oncology patients presenting with fever and neutropenia. A blood culture was collected at t0 and monitored for 5 days for bacterial growth. PCT value of 0.5 ng/mL at either t0 or t1 was considered predictive for bacteremia. RESULTS PCT levels were significantly higher in children with positive blood cultures than with negative blood cultures. Serial PCT values mirrored t1 values. Serial PCT showed 76% specificity and negative predictive value of 93% in ruling out bacteremia. CONCLUSION Elevated PCT levels are predictive of bacteremia. Using serial PCT levels within 24 hours allowed a better prediction of bacteremia than the PCT level at t0.
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Affiliation(s)
- Aaron J Reitman
- University of California, San Francisco-Fresno, Fresno, CA 90027, USA.
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Baseline evaluation of serum markers of inflammation and their utility in clinical practice in paediatric liver transplant recipients. Clin Res Hepatol Gastroenterol 2012; 36:365-70. [PMID: 22440053 DOI: 10.1016/j.clinre.2012.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 01/13/2012] [Accepted: 01/21/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several biomarkers of penetrating infections vs. rejection in liver transplant (LT) have been suggested; however, baseline values in paediatric LT recipients have not been studied. AIM We evaluated the baseline concentration of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) in a post-LT paediatric group. METHODS We measured serum PCT, CRP and IL-6 in 58 consecutive paediatric LT recipients. Specimens were collected for group 1 (n=22) at day 1, group 2 (n=12) at day 7 post-LT and group 3 (n=24) at onset of febrile episode. Day 7 samples were obtained from patients who had no graft dysfunction or signs/symptoms of sepsis. RESULTS Median values for PCT were: group 1 was 5.16 μg/L (95% CI, 2.18-21.13); group 2: 0.170 μg/L (95% CI, 0.15-0.36) and, group 3: 1.93 μg/L (95% CI, 1.36-2.66) for bacterial and fungal infection, 0.19 μg/L (95% CI, 0.10-0.48) for rejection, and 0.31 μg/L (95% CI, 0.15-0.44) for viral infection. The area under the ROC (AUROC) for PCT, CRP and IL-6 in bacterial infection vs. rejection was 1.0 (P<0.0001), 0.842 (95% CI 0.686-0.998; P<0.0001) and 0.739 (95% CI 0.559-0.919; P 0.0046), respectively. CONCLUSION PCT levels were significantly higher in bacterial and fungal infection in comparison to other inflammatory markers. PCT proved to be the most specific parameter in differentiating bacterial infection from viral infection and allograft rejection.
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Foushee JA, Hope NH, Grace EE. Applying biomarkers to clinical practice: a guide for utilizing procalcitonin assays. J Antimicrob Chemother 2012; 67:2560-9. [DOI: 10.1093/jac/dks265] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Dynamics of procalcitonin and bacteremia in neutropenic adults with acute myeloid leukemia. Leuk Res 2011; 35:1294-6. [DOI: 10.1016/j.leukres.2011.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 05/09/2011] [Accepted: 05/30/2011] [Indexed: 11/21/2022]
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Is there any influence of immune deficit on procalcitonin results? Hum Immunol 2011; 72:1194-7. [PMID: 21925227 DOI: 10.1016/j.humimm.2011.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 08/09/2011] [Accepted: 08/25/2011] [Indexed: 11/20/2022]
Abstract
The role of procalcitonin (PCT) in immunocompromised patients is still under investigation. This study evaluated the influence of immune deficiency on the value of PCT concentrations in the diagnosis of early stages of bacterial infections in human immunodeficiency virus (HIV)-infected patients compared with other inflammatory markers, such as C-reactive protein and white blood cell count. We analyzed major immunologic markers including CD4, CD8, and HIV-1 viral load. PCT concentrations in the early stages of bacterial infections correlated negatively with CD4 count in HIV-infected patients. However, a similar relation was not seen in patients with acquired immune deficiency syndrome. We support the recommendation to change the cutoff value ranges of PCT in patients with immune deficiency. PCT concentrations can be influenced by various factors and hence should be carefully analyzed, especially in immunocompromised patients.
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Evaluation of procalcitonin and CRP as sepsis markers in 74 consecutive patients admitted with prolonged febrile neutropenia. J Infect 2011; 63:93-5. [PMID: 21658771 DOI: 10.1016/j.jinf.2011.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/12/2011] [Accepted: 05/14/2011] [Indexed: 11/21/2022]
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Robinson JO, Lamoth F, Bally F, Knaup M, Calandra T, Marchetti O. Monitoring procalcitonin in febrile neutropenia: what is its utility for initial diagnosis of infection and reassessment in persistent fever? PLoS One 2011; 6:e18886. [PMID: 21541027 PMCID: PMC3081821 DOI: 10.1371/journal.pone.0018886] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 03/23/2011] [Indexed: 02/06/2023] Open
Abstract
Background Management of febrile neutropenic episodes (FE) is challenged by lacking microbiological and clinical documentation of infection. We aimed at evaluating the utility of monitoring blood procalcitonin (PCT) in FE for initial diagnosis of infection and reassessment in persistent fever. Methods PCT kinetics was prospectively monitored in 194 consecutive FE (1771 blood samples): 65 microbiologically documented infections (MDI, 33.5%; 49 due to non-coagulase-negative staphylococci, non-CNS), 68 clinically documented infections (CDI, 35%; 39 deep-seated), and 61 fever of unexplained origin (FUO, 31.5%). Results At fever onset median PCT was 190 pg/mL (range 30–26'800), without significant difference among MDI, CDI and FUO. PCT peak occurred on day 2 after onset of fever: non-CNS-MDI/deep-seated-CDI (656, 80–86350) vs. FUO (205, 33–771; p<0.001). PCT >500 pg/mL distinguished non-CNS-MDI/deep-seated-CDI from FUO with 56% sensitivity and 90% specificity. PCT was >500 pg/ml in only 10% of FUO (688, 570–771). A PCT peak >500 pg/mL (1196, 524–11950) occurred beyond 3 days of persistent fever in 17/21 (81%) invasive fungal diseases (IFD). This late PCT peak identified IFD with 81% sensitivity and 57% specificity and preceded diagnosis according to EORTC-MSG criteria in 41% of cases. In IFD responding to therapy, median days to PCT <500 pg/mL and defervescence were 5 (1–23) vs. 10 (3–22; p = 0.026), respectively. Conclusion While procalcitonin is not useful for diagnosis of infection at onset of neutropenic fever, it may help to distinguish a minority of potentially severe infections among FUOs on day 2 after onset of fever. In persistent fever monitoring procalcitonin contributes to early diagnosis and follow-up of invasive mycoses.
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Affiliation(s)
- James Owen Robinson
- Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Australia
- * E-mail: (OM); (JOR)
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Frank Bally
- Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marlies Knaup
- Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- * E-mail: (OM); (JOR)
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Koivula I, Hämäläinen S, Jantunen E, Pulkki K, Kuittinen T, Nousiainen T, Juutilainen A. Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia. ACTA ACUST UNITED AC 2011; 43:471-8. [PMID: 21299364 DOI: 10.3109/00365548.2011.554855] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare semi-quantitative procalcitonin with C-reactive protein in predicting bacteraemia in haematological patients with neutropenic fever. METHODS A total of 77 patients treated with intensive chemotherapy for haematological malignancy at Kuopio University Hospital were candidates for study entry. Eleven of these patients did not fulfil the criteria for neutropenic fever, and 66 patients were finally included. Nineteen patients had acute myeloid leukaemia and 47 had received high-dose chemotherapy supported by autologous stem cell transplant. Ninety neutropenic fever episodes in these 66 patients fulfilled the study entry criteria, with microbiological cultures, procalcitonin and C-reactive protein measurements available. Serum procalcitonin and C-reactive protein were analyzed at the onset of each neutropenic fever episode on day 0, and then daily from days 1 to 4. RESULTS Bacteraemia was observed in 21 episodes (23%) and the criteria for severe sepsis were fulfilled in 13 episodes (14%). Half of the bacteraemic episodes were caused by Gram-negative bacteria. The kinetics of procalcitonin and C-reactive protein were similar, with increasing levels for 2 to 4 days after the onset of fever. The procalcitonin level on days 1, 2, 3 and 4 was associated with bacteraemia and Gram-negative bacteraemia, but not with the development of severe sepsis. On day 1, a procalcitonin level above 0.5 ng/ml had a sensitivity of 57% and 70% and specificity of 81% and 77% to predict bacteraemia and Gram-negative bacteraemia, respectively. CONCLUSIONS An elevated level of procalcitonin within 24 h after the onset of neutropenic fever predicts bacteraemia and Gram-negative bacteraemia in haematological patients.
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Affiliation(s)
- Irma Koivula
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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Mori Y, Miyawaki K, Kato K, Takenaka K, Iwasaki H, Harada N, Miyamoto T, Akashi K, Teshima T. Diagnostic value of serum procalcitonin and C-reactive protein for infections after allogeneic hematopoietic stem cell transplantation versus nontransplant setting. Intern Med 2011; 50:2149-55. [PMID: 21963733 DOI: 10.2169/internalmedicine.50.5798] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Procalcitonin (PCT) has been increasingly used as a biomarker of infection. The purpose of this study was to evaluate its diagnostic value after hematopoietic stem cell transplantation (HSCT), where non-infectious febrile complications such as graft-versus-host disease frequently develop. METHODS We retrospectively analyzed 144 febrile episodes (infections: 82, and noninfections: 62) in adult patients with hematological disorders, including 57 and 87 episodes in HSCT and non-HSCT patients, respectively. RESULTS Of 57 febrile episodes in HSCT patients, 46 (86%) and 25 (44%) revealed positivity for C-reactive protein (CRP) and PCT, respectively. Among 87 febrile episodes in non-HSCT patients, 81 (93%) and 22 (25%) events showed positive results of CRP and PCT. Both of these biomarkers were associated with infectious episodes in univariate analysis. Multivariate analysis showed that a high cut-off level (>9.5 mg/dL) of CRP was a better indicator for infections than PCT in HSCT patients, while PCT positivity was more diagnostic for infections than any cutoff CRP level in non-HSCT patients. CONCLUSION It may be necessary to interpret the results of these biomarkers with different orders of priority in transplant versus nontransplant patients.
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Affiliation(s)
- Yasuo Mori
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Japan
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45
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Azoulay E. Minimally Invasive Diagnostic Strategy in Immunocompromised Patients with Pulmonary Infiltrates. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7123161 DOI: 10.1007/978-3-642-15742-4_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acute respiratory failure (ARF) is the main reason for ICU admission in patients with haematological malignancies. High mortality rates of up to 50% are reported in this situation, and mortality is highest when mechanical ventilation is needed. Rapid and accurate diagnostic methods are needed in these vulnerable patients to ensure the prompt initiation of effective treatment. However, the broad array of possible cause of ARF raises diagnostic challenges. In this review, we discuss the DIRECT strategy, which identifies the most plausible diagnosis in each patient based on the type of immune deficiency and clinical presentation. We will focus on non-invasive laboratory tests developed in recent years, discussing their sensitivity and specificity. We also discuss the usefulness in cancer patients with specific organ dysfunctions of biomarkers introduced over the past few years.
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Affiliation(s)
- Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010 France
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46
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Sarmati L, Beltrame A, Dori L, Maffongelli G, Cudillo L, De Angelis G, Picardi A, Ottaviani L, Cefalo MG, Venditti A, Amadori S, Arcese W, Andreoni M. Procalcitonin is a reliable marker of severe systemic infection in neutropenic haematological patients with mucositis. Am J Hematol 2010; 85:380-3. [PMID: 20425801 DOI: 10.1002/ajh.21685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K. The Role of Procalcitonin in Febrile Neutropenic Patients: Review of the Literature. Infection 2008; 36:396-407. [DOI: 10.1007/s15010-008-7374-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 02/14/2008] [Indexed: 12/01/2022]
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48
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Ramzi J, Mohamed Z, Yosr B, Karima K, Raihane B, Lamia A, Hela BA, Zaher B, Balkis M. Predictive factors of septic shock and mortality in neutropenic patients. ACTA ACUST UNITED AC 2008; 12:543-8. [PMID: 17852435 DOI: 10.1080/10245330701384237] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Neutropenia is a major risk factor for developing a serious infection. Bacteremia still causes significant mortality among neutropenic patients with cancer. The purpose of this study was to identify risk factors for septic shock and for mortality in neutropenic patients with leukemia and bacteremia. Consecutive samples from 20 patients with acute myeloid leukemia and bacteremia were studied during a 1 year period (January-December 2003). All patients received empirical antibiotic therapies for febrile episodes using ceftazidime plus amikacin. About 110 neutropenic febrile episodes were noted: clinically documented 14.54%, microbiologically documented 16.36% and fever of unknown origin 69.09%. Gram-negative organism caused eight febrile episodes: Pseudomonas (5), Klebsiella (3). Gram-positive organism caused 10 episodes: Staphylococcus (6), Streptococci (2), Enterococci (2). Pulmonary infection accounted for 25% of clinically documented infections. About 14 of the 110 febrile episodes were associated with septic shock causing mortality in 7 patients. In a univariate analysis variables associated with septic shock were: pulmonary infection (OR = 17, p = 0.001), serum bicarbonate < 17 mmol/l (OR = 68, p < 0.001) and serum lactate >3 mmol/l (OR = 62, p < 0.001). Variables associated with mortality were: pulmonary infection (OR = 83, p < 0.001) and serum bicarbonate < 17 mmol/l (OR = 61, p < 0.001). In a multivariate analysis two variables were associated with septic shock: pulmonary infection (OR = 5, p = 0.043) and serum lactate >3 mmol/l (OR = 10, p = 0.003). An elevated serum lactate (>3 mmol/l) and low serum bicarbonate ( < 17 mmol/l) at the onset of bacteremia are useful biomarkers in predicting septic shock and mortality in neutropenic patients.
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Affiliation(s)
- Jeddi Ramzi
- Department of Hematology Place du gouvernement la Kasbah, Aziza Othmana University Hospital, Tunis, Tunisia.
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Uys A, Rapoport BL, Fickl H, Meyer PWA, Anderson R. Prediction of outcome in cancer patients with febrile neutropenia: comparison of the Multinational Association of Supportive Care in Cancer risk-index score with procalcitonin, C-reactive protein, serum amyloid A, and interleukins-1beta, -6, -8 and -10. Eur J Cancer Care (Engl) 2008; 16:475-83. [PMID: 17944761 DOI: 10.1111/j.1365-2354.2007.00780.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The primary objective of the study was to compare the predictive potential of procalcitonin (PCT), C-reactive protein (CRP), serum amyloid A (SAA), and interleukin (IL)-1beta, IL-6, IL-8, and IL-10, with that of the Multinational Association of Supportive Care in Cancer (MASCC) risk-index score in cancer patients on presentation with chemotherapy-induced febrile neutropenia (FN). Seventy-eight consecutive FN episodes in 63 patients were included, and MASCC scores, as well as concentrations of CRP, SAA, PCT, and IL-1beta, IL-6, IL-8 and IL-10, and haematological parameters were determined on presentation, 72 h later and at outcome. Multivariate analysis of data revealed the MASCC score, but none of the laboratory parameters, to be an accurate, independent variable (P < 0.0001) for prediction of resolution with or without complications and death. Of the various laboratory parameters, PCT had the strongest association with the MASCC score (r = -0.51; P < 0.0001). In cancer patients who present with FN, the MASCC risk-index score is a useful predictor of outcome, while measurement of PCT, CRP, SAA, or IL-1beta, IL-6, IL-8 and IL-10, is of limited value.
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Affiliation(s)
- A Uys
- The Medical Oncology Centre of Rosebank, Johannesburg, South Africa.
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Mikuła T, Lipowski D, Stańczak W. The serum concentration of procalcitonin (PCT) in various infections in HIV positive patients. HIV & AIDS REVIEW 2008. [DOI: 10.1016/s1730-1270(10)60002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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