COMPARISON OF PRESEPSIN, PROCALCITONIN, INTERLEUKIN-8 AND C-REACTIVE PROTEIN IN PREDICTING BACTERAEMIA IN FEBRILE NEUTROPENIC ADULT PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES
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Abstract
Bacterial infections represent life-threatening complications in patients with febrile neutropenia (FN). Biomarkers of infections may help to differentiate bacteraemia from non-bacteraemia FN. We aimed to evaluate the utility of procalcitonin (PCT), presepsin (PS), C-reactive protein (CRP) and interleukin-8 (IL-8) as biomarkers of bacteraemia in adult FN patients with haematological malignancies. Thirty-six FN episodes experienced by 28 oncohematological patients were considered. 11 out of 36 episodes were classified as bacteraemia. PCT was the best biomarker to predict bacteraemia with area under the curve (AUC) ROC of 0,9; while the most sensitive was IL-8 (90,9%) with AUC ROC of 0,88. All patients with PCT concentrations above 1,6 ?g/l had bacteraemia. Patients with IL-8 concentrations > 170 pg/ml or PS concentrations superior then 410 pg/ml had 40 times and 24 times higher risk for bacteraemia, respectively. PCT remains better than IL-8 and PS in predicting bacteraemia in adult hematological patients with FN.
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References
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https://doi.org/10.1007/s00277-017-3128-1 PMid:28920169
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https://doi.org/10.4084/mjhid.2019.023 PMid:30858961 PMCid:PMC6402549
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https://doi.org/10.3343/alm.2014.34.4.263 PMid:24982830 PMCid:PMC4071182
24. Masson S, Caironi P, Spanuth E, et al. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial. Crit Care. 2014;18: R6.
https://doi.org/10.1186/cc13183 PMid:24393424 PMCid:PMC4056046
https://doi.org/10.1086/383050 PMid:15250018
2. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52: e56-93.
https://doi.org/10.1093/cid/cir073 PMid:21258094
3. Póvoa P. C-reactive protein: a valuable marker of sepsis. Intensive Care Med. 2002;28: 235-243.
https://doi.org/10.1007/s00134-002-1209-6 PMid:11904651
4. Pierrakos C, Vincent JL. Sepsis biomarkers: a review. Crit Care. 2010;14: R15.
https://doi.org/10.1186/cc8872 PMid:20144219 PMCid:PMC2875530
www.mjhid.org Mediterr J Hematol Infect Dis 2019; 11; e2019047 Pag. 7 / 7
5. Chenevier-Gobeaux C, Borderie D, Weiss N, Mallet-Coste T, Claessens YE. Presepsin (sCD14-ST), an innate immune response marker in sepsis. Clin Chim Acta. 2015;450: 97-103.
https://doi.org/10.1016/j.cca.2015.06.026 PMid:26164388
6. Arai Y, Mizugishi K, Nonomura K, Naitoh K, Takaori-Kondo A, Yamashita K. Phagocytosis by human monocytes is required for the secretion of presepsin. J Infect Chemother. 2015;21: 564-569.
https://doi.org/10.1016/j.jiac.2015.04.011 PMid:26026662
7. Zhang J, Hu ZD, Song J, Shao J. Diagnostic Value of Presepsin for Sepsis: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2015;94: e2158.
https://doi.org/10.1097/MD.0000000000002158 PMid:26632748 PMCid:PMC5059017
8. From the Immunocompromised Host Society. The design, analysis, and reporting of clinical trials on the empirical antibiotic management of the neutropenic patient. Report of a consensus panel. J Infect Dis. 1990;161: 397-401.
https://doi.org/10.1093/infdis/161.3.397 PMid:2179421
9. Santolaya ME, Cofre J, Beresi V. C-reactive protein: a valuable aid for the management of febrile children with cancer and neutropenia. Clin Infect Dis. 1994;18: 589-595.
https://doi.org/10.1093/clinids/18.4.589 PMid:8038314
10. Wu CC, Lan HM, Han ST, et al. Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and C-reactive protein: a systematic review and meta-analysis. Ann Intensive Care. 2017;7: 91.
https://doi.org/10.1186/s13613-017-0316-z PMid:28875483 PMCid:PMC5585118
11. Koh H, Aimoto M, Katayama T, et al. Diagnostic value of levels of presepsin (soluble CD14-subtype) in febrile neutropenia in patients with hematological disorders. J Infect Chemother. 2016;22: 466-471.
https://doi.org/10.1016/j.jiac.2016.04.002 PMid:27184936
12. Urbonas V, Eidukait? A, Tamulien? I. The predictive value of soluble biomarkers (CD14 subtype, interleukin-2 receptor, human leucocyte antigen-G) and procalcitonin in the detection of bacteremia and sepsis in pediatric oncology patients with chemotherapy-induced febrile neutropenia. Cytokine. 2013;62: 34-37.
https://doi.org/10.1016/j.cyto.2013.02.030 PMid:23510625
13. Stoma I, Karpov I, Uss A, Rummo O, Milanovich N, Iskrov I. Diagnostic value of sepsis biomarkers in hematopoietic stem cell transplant recipients in a condition of high prevalence of gram-negative pathogens. Hematol Oncol Stem Cell Ther. 2017;10: 15-21.
https://doi.org/10.1016/j.hemonc.2016.09.002 PMid:27793578
14. Baraka A, Zakaria M. Presepsin as a diagnostic marker of bacterial infections in febrile neutropenic pediatric patients with hematological malignancies. Int J Hematol. 2018;108: 184-191.
https://doi.org/10.1007/s12185-018-2447-x PMid:29616457
15. Ebihara Y, Kobayashi K, Ishida A, et al. Diagnostic performance of procalcitonin, presepsin, and C-reactive protein in patients with hematological malignancies. J Clin Lab Anal. 2017;31.
https://doi.org/10.1002/jcla.22147 PMid:28133789
16. Koizumi Y, Shimizu K, Shigeta M, et al. Plasma presepsin level is an early diagnostic marker of severe febrile neutropenia in hematologic malignancy patients. BMC Infect Dis. 2017;17: 27.
https://doi.org/10.1186/s12879-016-2116-8 PMid:28056845 PMCid:PMC5217328
17. Lissauer ME, Johnson SB, Bochicchio GV, et al. Differential expression of toll-like receptor genes: sepsis compared with sterile inflammation 1 day before sepsis diagnosis. Shock. 2009;31: 238-244.
https://doi.org/10.1097/SHK.0b013e3181834991 PMid:18665047
18. ?ahbudak Bal Z, Karada? Özdemir N, ?en S, et al. Diagnostic Accuracy of Interleukin-6, Interleukin-8, and Interleukin-10 for Predicting Bacteremia in Children with Febrile Neutropenia. Turk J Haematol. 2017;34: 254-257.
https://doi.org/10.4274/tjh.2016.0434 PMid:28148470 PMCid:PMC5544046
19. Santolaya ME, Alvarez AM, Aviles CL, et al. Predictors of severe sepsis not clinically apparent during the first twenty-four hours of hospitalization in children with cancer, neutropenia, and fever: a prospective, multicenter trial. Pediatr Infect Dis J. 2008;27: 538-543.
https://doi.org/10.1097/INF.0b013e3181673c3c PMid:18458649
20. Miedema KG, Vermont CL, Ball LM, et al. The diagnostic value of interleukin-8 for the detection of bacteremia in pediatric hematopoietic stem cell recipients with febrile neutropenia. Transplantation. 2014;98: e80-81.
https://doi.org/10.1097/TP.0000000000000434 PMid:25318571
21. Michel CS, Teschner D, Wagner EM, Theobald M, Radsak MP. Diagnostic value of sTREM-1, IL-8, PCT, and CRP in febrile neutropenia after autologous stem cell transplantation. Ann Hematol. 2017;96: 2095-2101.
https://doi.org/10.1007/s00277-017-3128-1 PMid:28920169
22. Verlinden A, De Vroey V, Goossens H, et al. 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.
https://doi.org/10.4084/mjhid.2019.023 PMid:30858961 PMCid:PMC6402549
23. Meisner M. Update on procalcitonin measurements. Ann Lab Med. 2014;34: 263-273.
https://doi.org/10.3343/alm.2014.34.4.263 PMid:24982830 PMCid:PMC4071182
24. Masson S, Caironi P, Spanuth E, et al. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial. Crit Care. 2014;18: R6.
https://doi.org/10.1186/cc13183 PMid:24393424 PMCid:PMC4056046