DIAGNOSTIC VALUE OF PLASMA LEVELS OF PRESEPSIN (SOLUBLE CD14-SUBTYPE) FOR FEBRILE NEUTROPENIA IN PATIENTS WITH HEMATOLOGIC MALIGNANCIES
(Abstract release date: 05/21/15)
EHA Library. Koh H. 06/12/15; 102677; PB1805
Disclosure(s): Osaka City UniversityHematology
Hideo Koh
Contributions
Contributions
Abstract
Abstract: PB1805
Type: Publication Only
Background
Previous studies reported that procalcitonin (PCT), C-reactive protein (CRP) and cytokines such as interleukin (IL)-6 and IL-8 may be useful as biomarkers of bacterial infections in the management of febrile neutropenia (FN). CD14, one of the surface markers in monocytes/macrophages, is a lipopolysaccharide-binding protein complex receptor, and its fragment “presepsin (soluble CD14-subtype)” has recently been reported as a novel diagnostic biomarker of infection, especially sepsis (Endo S, et al. 2012). However, the superiority of this test in FN, compared with the other markers, is unknown.
Aims
The purpose of the study was to examine whether presepsin was a superior diagnostic marker for bacterial infections in comparison with PCT, CRP, IL-6 and IL-8.
Methods
We prospectively evaluated the utility of these biomarkers in patients with hematological disorders who developed FN during chemotherapy between Nov 2013 and Feb 2014. FN was defined as an axillary temperature ≥ 37.5 ? recorded once with a neutrophil count <500/μl or <1,000/μl with an expected decline to <500/μl. Patients were closely and frequently monitored to assess precisely differences in kinetics among these markers. Thus, blood samples for these measurements were collected simultaneously at the following time points: once before chemotherapy as a control, 3 times per week until onset of FN after chemotherapy, at onset of FN, at 8, 16, 24, 48 and 72 hours after the onset of FN, and every 48 hours after that until resolution of fever, in accordance with the protocol. Plasma presepsin was determined by the PATHFAST® Presepsin kit (LSI Medience Corporation, Japan). Serum levels of CRP, PCT and cytokines were measured by nephelometry, electrochemiluminescence immunoassay and the Bio-Plex Pro Cytokine Assay® system (Bio-Rad Laboratories, CA), respectively.
Results
A total of four patients aged 29–54 years were enrolled and four FN episodes were evaluable. The underlying diseases were acute leukemia in three patients and one case of non-Hodgkin’s lymphoma. Concerning the cause of FN, Patient no.1 (P1), P2, P3 and P4 were finally diagnosed as having a fever of unknown origin, suspected drug fever, clinically documented local infection and Staphylococcus aureus bacteremia, respectively. The number of times each of these patients was sampled was 18, 17, 18 and 15 respectively. A result was considered to be positive if it met the following criteria: 314 pg/ml for presepsin, 0.30 mg/dl for CRP, 0.05 ng/ml for PCT, and the levels of the baseline controls sampled before chemotherapy for both IL-6 and IL-8, respectively. The presepsin peak levels from the onset of FN to 24 hours in P1, P2, P3 and P4 were 330, 148, 348 and 460 pg/ml, respectively. The corresponding levels of CRP, PCT, IL-6 and IL-8 in P1, P2, P3 and P4 were 1.8, 6.0, 11.9 and 4.9 mg/dl; 0.04, 0.34, 0.36 and 0.22 ng/ml; 14 (baseline, 27), 107 (23), 69 (25) and 24 (8.4) pg/ml; and 52 (62), 787 (58), 56 (150) and 26 (13) pg/ml, respectively. In P2, where no infection was suspected, presepsin was the only marker that did not increase. This suggests that presepsin might be useful to differentiate infectious from non-infectious causes of FN.
Summary
Our results suggest that presepsin may be more useful than CRP, PCT, IL-6 and IL-8 in the management of FN, especially when attempting to rule out the presence of serious bacterial infections.
Keyword(s): Clinical data, Diagnosis, Febrile neutropenia, Infection
Session topic: Publication Only
Type: Publication Only
Background
Previous studies reported that procalcitonin (PCT), C-reactive protein (CRP) and cytokines such as interleukin (IL)-6 and IL-8 may be useful as biomarkers of bacterial infections in the management of febrile neutropenia (FN). CD14, one of the surface markers in monocytes/macrophages, is a lipopolysaccharide-binding protein complex receptor, and its fragment “presepsin (soluble CD14-subtype)” has recently been reported as a novel diagnostic biomarker of infection, especially sepsis (Endo S, et al. 2012). However, the superiority of this test in FN, compared with the other markers, is unknown.
Aims
The purpose of the study was to examine whether presepsin was a superior diagnostic marker for bacterial infections in comparison with PCT, CRP, IL-6 and IL-8.
Methods
We prospectively evaluated the utility of these biomarkers in patients with hematological disorders who developed FN during chemotherapy between Nov 2013 and Feb 2014. FN was defined as an axillary temperature ≥ 37.5 ? recorded once with a neutrophil count <500/μl or <1,000/μl with an expected decline to <500/μl. Patients were closely and frequently monitored to assess precisely differences in kinetics among these markers. Thus, blood samples for these measurements were collected simultaneously at the following time points: once before chemotherapy as a control, 3 times per week until onset of FN after chemotherapy, at onset of FN, at 8, 16, 24, 48 and 72 hours after the onset of FN, and every 48 hours after that until resolution of fever, in accordance with the protocol. Plasma presepsin was determined by the PATHFAST® Presepsin kit (LSI Medience Corporation, Japan). Serum levels of CRP, PCT and cytokines were measured by nephelometry, electrochemiluminescence immunoassay and the Bio-Plex Pro Cytokine Assay® system (Bio-Rad Laboratories, CA), respectively.
Results
A total of four patients aged 29–54 years were enrolled and four FN episodes were evaluable. The underlying diseases were acute leukemia in three patients and one case of non-Hodgkin’s lymphoma. Concerning the cause of FN, Patient no.1 (P1), P2, P3 and P4 were finally diagnosed as having a fever of unknown origin, suspected drug fever, clinically documented local infection and Staphylococcus aureus bacteremia, respectively. The number of times each of these patients was sampled was 18, 17, 18 and 15 respectively. A result was considered to be positive if it met the following criteria: 314 pg/ml for presepsin, 0.30 mg/dl for CRP, 0.05 ng/ml for PCT, and the levels of the baseline controls sampled before chemotherapy for both IL-6 and IL-8, respectively. The presepsin peak levels from the onset of FN to 24 hours in P1, P2, P3 and P4 were 330, 148, 348 and 460 pg/ml, respectively. The corresponding levels of CRP, PCT, IL-6 and IL-8 in P1, P2, P3 and P4 were 1.8, 6.0, 11.9 and 4.9 mg/dl; 0.04, 0.34, 0.36 and 0.22 ng/ml; 14 (baseline, 27), 107 (23), 69 (25) and 24 (8.4) pg/ml; and 52 (62), 787 (58), 56 (150) and 26 (13) pg/ml, respectively. In P2, where no infection was suspected, presepsin was the only marker that did not increase. This suggests that presepsin might be useful to differentiate infectious from non-infectious causes of FN.
Summary
Our results suggest that presepsin may be more useful than CRP, PCT, IL-6 and IL-8 in the management of FN, especially when attempting to rule out the presence of serious bacterial infections.
Keyword(s): Clinical data, Diagnosis, Febrile neutropenia, Infection
Session topic: Publication Only
Abstract: PB1805
Type: Publication Only
Background
Previous studies reported that procalcitonin (PCT), C-reactive protein (CRP) and cytokines such as interleukin (IL)-6 and IL-8 may be useful as biomarkers of bacterial infections in the management of febrile neutropenia (FN). CD14, one of the surface markers in monocytes/macrophages, is a lipopolysaccharide-binding protein complex receptor, and its fragment “presepsin (soluble CD14-subtype)” has recently been reported as a novel diagnostic biomarker of infection, especially sepsis (Endo S, et al. 2012). However, the superiority of this test in FN, compared with the other markers, is unknown.
Aims
The purpose of the study was to examine whether presepsin was a superior diagnostic marker for bacterial infections in comparison with PCT, CRP, IL-6 and IL-8.
Methods
We prospectively evaluated the utility of these biomarkers in patients with hematological disorders who developed FN during chemotherapy between Nov 2013 and Feb 2014. FN was defined as an axillary temperature ≥ 37.5 ? recorded once with a neutrophil count <500/μl or <1,000/μl with an expected decline to <500/μl. Patients were closely and frequently monitored to assess precisely differences in kinetics among these markers. Thus, blood samples for these measurements were collected simultaneously at the following time points: once before chemotherapy as a control, 3 times per week until onset of FN after chemotherapy, at onset of FN, at 8, 16, 24, 48 and 72 hours after the onset of FN, and every 48 hours after that until resolution of fever, in accordance with the protocol. Plasma presepsin was determined by the PATHFAST® Presepsin kit (LSI Medience Corporation, Japan). Serum levels of CRP, PCT and cytokines were measured by nephelometry, electrochemiluminescence immunoassay and the Bio-Plex Pro Cytokine Assay® system (Bio-Rad Laboratories, CA), respectively.
Results
A total of four patients aged 29–54 years were enrolled and four FN episodes were evaluable. The underlying diseases were acute leukemia in three patients and one case of non-Hodgkin’s lymphoma. Concerning the cause of FN, Patient no.1 (P1), P2, P3 and P4 were finally diagnosed as having a fever of unknown origin, suspected drug fever, clinically documented local infection and Staphylococcus aureus bacteremia, respectively. The number of times each of these patients was sampled was 18, 17, 18 and 15 respectively. A result was considered to be positive if it met the following criteria: 314 pg/ml for presepsin, 0.30 mg/dl for CRP, 0.05 ng/ml for PCT, and the levels of the baseline controls sampled before chemotherapy for both IL-6 and IL-8, respectively. The presepsin peak levels from the onset of FN to 24 hours in P1, P2, P3 and P4 were 330, 148, 348 and 460 pg/ml, respectively. The corresponding levels of CRP, PCT, IL-6 and IL-8 in P1, P2, P3 and P4 were 1.8, 6.0, 11.9 and 4.9 mg/dl; 0.04, 0.34, 0.36 and 0.22 ng/ml; 14 (baseline, 27), 107 (23), 69 (25) and 24 (8.4) pg/ml; and 52 (62), 787 (58), 56 (150) and 26 (13) pg/ml, respectively. In P2, where no infection was suspected, presepsin was the only marker that did not increase. This suggests that presepsin might be useful to differentiate infectious from non-infectious causes of FN.
Summary
Our results suggest that presepsin may be more useful than CRP, PCT, IL-6 and IL-8 in the management of FN, especially when attempting to rule out the presence of serious bacterial infections.
Keyword(s): Clinical data, Diagnosis, Febrile neutropenia, Infection
Session topic: Publication Only
Type: Publication Only
Background
Previous studies reported that procalcitonin (PCT), C-reactive protein (CRP) and cytokines such as interleukin (IL)-6 and IL-8 may be useful as biomarkers of bacterial infections in the management of febrile neutropenia (FN). CD14, one of the surface markers in monocytes/macrophages, is a lipopolysaccharide-binding protein complex receptor, and its fragment “presepsin (soluble CD14-subtype)” has recently been reported as a novel diagnostic biomarker of infection, especially sepsis (Endo S, et al. 2012). However, the superiority of this test in FN, compared with the other markers, is unknown.
Aims
The purpose of the study was to examine whether presepsin was a superior diagnostic marker for bacterial infections in comparison with PCT, CRP, IL-6 and IL-8.
Methods
We prospectively evaluated the utility of these biomarkers in patients with hematological disorders who developed FN during chemotherapy between Nov 2013 and Feb 2014. FN was defined as an axillary temperature ≥ 37.5 ? recorded once with a neutrophil count <500/μl or <1,000/μl with an expected decline to <500/μl. Patients were closely and frequently monitored to assess precisely differences in kinetics among these markers. Thus, blood samples for these measurements were collected simultaneously at the following time points: once before chemotherapy as a control, 3 times per week until onset of FN after chemotherapy, at onset of FN, at 8, 16, 24, 48 and 72 hours after the onset of FN, and every 48 hours after that until resolution of fever, in accordance with the protocol. Plasma presepsin was determined by the PATHFAST® Presepsin kit (LSI Medience Corporation, Japan). Serum levels of CRP, PCT and cytokines were measured by nephelometry, electrochemiluminescence immunoassay and the Bio-Plex Pro Cytokine Assay® system (Bio-Rad Laboratories, CA), respectively.
Results
A total of four patients aged 29–54 years were enrolled and four FN episodes were evaluable. The underlying diseases were acute leukemia in three patients and one case of non-Hodgkin’s lymphoma. Concerning the cause of FN, Patient no.1 (P1), P2, P3 and P4 were finally diagnosed as having a fever of unknown origin, suspected drug fever, clinically documented local infection and Staphylococcus aureus bacteremia, respectively. The number of times each of these patients was sampled was 18, 17, 18 and 15 respectively. A result was considered to be positive if it met the following criteria: 314 pg/ml for presepsin, 0.30 mg/dl for CRP, 0.05 ng/ml for PCT, and the levels of the baseline controls sampled before chemotherapy for both IL-6 and IL-8, respectively. The presepsin peak levels from the onset of FN to 24 hours in P1, P2, P3 and P4 were 330, 148, 348 and 460 pg/ml, respectively. The corresponding levels of CRP, PCT, IL-6 and IL-8 in P1, P2, P3 and P4 were 1.8, 6.0, 11.9 and 4.9 mg/dl; 0.04, 0.34, 0.36 and 0.22 ng/ml; 14 (baseline, 27), 107 (23), 69 (25) and 24 (8.4) pg/ml; and 52 (62), 787 (58), 56 (150) and 26 (13) pg/ml, respectively. In P2, where no infection was suspected, presepsin was the only marker that did not increase. This suggests that presepsin might be useful to differentiate infectious from non-infectious causes of FN.
Summary
Our results suggest that presepsin may be more useful than CRP, PCT, IL-6 and IL-8 in the management of FN, especially when attempting to rule out the presence of serious bacterial infections.
Keyword(s): Clinical data, Diagnosis, Febrile neutropenia, Infection
Session topic: Publication Only
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