PRESEPSIN (SOLUBLE CD14 SUBTYPE) IS ELEVATED IN FEBRILE NEUTROPENIC PATIENTS WITH HEMATOLOGICAL MALIGNANCY: USEFULNESS AS ONE ANOTHER BIOMAKER
(Abstract release date: 05/19/16)
EHA Library. Sugawara N. 06/09/16; 132727; E1178
Dr. Norifumi Sugawara
Contributions
Contributions
Abstract
Abstract: E1178
Type: Eposter Presentation
Background
ebrile neutropenia (FN) is often observed in patients with hematological malignancy (HEM). Most of causes are bacterial infections in these FN, and many cases respond to empirical antibiotic therapy including an anti-pseudomonas b-lactam agent. Otherwise, it is often difficult to specify the focus and pathogen of infection in FN patients. Presepsin (Pre-SEP) is a subtype of soluble CD14, which is a receptor for lipopolysaccharide (LPS)/LPS-binding protein complexes and is expressed on the myelo-monocytic cell surface. Recently, it has been shown to be a useful biomarker for assessing the severity of sepsis and has come into use in the field of critical care medicine. However, little is known about the biological characteristics of Pre-SEP in FN patients.
Aims
To clarify the usefulness of new biomarker Pre-SEP in the setting of neutropenia, we performed analyses to determine the clinical relevance of Pre-SEP in the diagnosis of bacteremia or other infectious complications as a biomarker for FN patients after or during chemotherapy in HEM.
Methods
We measured the plasma concentration of Pre-SEP, procalcitonin (PCT) and C-reactive protein (CRP) at Day0, 2, 4, 7, 14 and 21 after the onset of FN, and compared them to those of non-febrile neutropenic patients. Furthermore we reviewed other clinical data including bacterial examination and clinical courses, and evaluated the utility of Pre-SEP as biomarker of FN.
Results
The 65 hospitalized FN patients with HEM (AML 16, ALL 12, MDS 14, NHL 13, MM 8, and ATL 2) were treated by IDSA guideline and administered antibacterial or antifungal agents, and the clinical data including Pre-SEP were evaluated. Pre-SEP (Day 0, 2, 4, 7, 14 and 21) was elevated (447 pg/ml (141-2204), 494 pg/ml (151-1975), 344 pg/ml (164-1264), 312 pg/ml (116-1512), 319 pg/ml (86-1512), 278 pg/ml (129-1425), p<0.05, respectively, cut off value: 314 pg/ml) compared to those in non-febrile neutropenic patients (196 pg/ml (97.5-453): median (range), respectively). Otherwise, PCT (Day 0, 2, 4, 7, 14 and 21) was also elevated (0.12 ng/ml (0.04-3.40), 0.13 ng/ml (0.05-1.60), 0.11 ng/ml (0.04-3.54), 0.08 ng/ml (0.03-8.21), 0.11 ng/ml (0.02-2.64), 0.36 ng/ml (0.10-7.75), p<0.05, respectively, cut off value: 0.05 ng/ml) compared to those in non-febrile neutropenic patients (0.175 ng/ml (0.06-1.91): median (range), respectively), and CRP (Day 0, 2, 4, 7, 14 and 21) was also elevated (5.07 mg/dl (0.19-27.83), 3.19 mg/dl (0.30-20.54), 2.26 mg/dl (0.15-34.01), 1.33 mg/dl (0.10-29.48), 0.28 mg/dl (0.10-22.49), 0.36 mg/dl (0.10-7.75), p<0.05, respectively, cut off value: 0.3 mg/dl) compared to those in non-febrile neutropenic patients (0.625 mg/dl (0.11-8.72): median (range), respectively). There was no relation between Pre-SEP value and bacterial examination data including blood cultures. Almost FN cases responded empirical antibacterial therapy, and elevated Pre-SEP, PCT and CRP values decreased again accompanied by defervescence. However, some cases of persistent remarkably elevated Pre-SEP cases ware observed, and these cases had very poor prognosis. The 5 of 9 cases with remarkably high Pre-SEP value (>1000 pg/ml) at both day7 and 14, or both day14 and 21 were dead by severe infection related events within 4 weeks, otherwise all other 56 cases than the above recovered from infection events and survived (p<0.05, respectively).
Conclusion
These data suggested that Pre-SEP is elevated due to active infection events in FN patients in spite of conditions being remarkably decreased neutrophil and monocyte. Pre-SEP is useful as a biomarker of infection in FN patients, as well as PCT or CRP.
Session topic: E-poster
Keyword(s): Febrile neutropenia, Hematological malignancy, Infection, Neutrophil
Type: Eposter Presentation
Background
ebrile neutropenia (FN) is often observed in patients with hematological malignancy (HEM). Most of causes are bacterial infections in these FN, and many cases respond to empirical antibiotic therapy including an anti-pseudomonas b-lactam agent. Otherwise, it is often difficult to specify the focus and pathogen of infection in FN patients. Presepsin (Pre-SEP) is a subtype of soluble CD14, which is a receptor for lipopolysaccharide (LPS)/LPS-binding protein complexes and is expressed on the myelo-monocytic cell surface. Recently, it has been shown to be a useful biomarker for assessing the severity of sepsis and has come into use in the field of critical care medicine. However, little is known about the biological characteristics of Pre-SEP in FN patients.
Aims
To clarify the usefulness of new biomarker Pre-SEP in the setting of neutropenia, we performed analyses to determine the clinical relevance of Pre-SEP in the diagnosis of bacteremia or other infectious complications as a biomarker for FN patients after or during chemotherapy in HEM.
Methods
We measured the plasma concentration of Pre-SEP, procalcitonin (PCT) and C-reactive protein (CRP) at Day0, 2, 4, 7, 14 and 21 after the onset of FN, and compared them to those of non-febrile neutropenic patients. Furthermore we reviewed other clinical data including bacterial examination and clinical courses, and evaluated the utility of Pre-SEP as biomarker of FN.
Results
The 65 hospitalized FN patients with HEM (AML 16, ALL 12, MDS 14, NHL 13, MM 8, and ATL 2) were treated by IDSA guideline and administered antibacterial or antifungal agents, and the clinical data including Pre-SEP were evaluated. Pre-SEP (Day 0, 2, 4, 7, 14 and 21) was elevated (447 pg/ml (141-2204), 494 pg/ml (151-1975), 344 pg/ml (164-1264), 312 pg/ml (116-1512), 319 pg/ml (86-1512), 278 pg/ml (129-1425), p<0.05, respectively, cut off value: 314 pg/ml) compared to those in non-febrile neutropenic patients (196 pg/ml (97.5-453): median (range), respectively). Otherwise, PCT (Day 0, 2, 4, 7, 14 and 21) was also elevated (0.12 ng/ml (0.04-3.40), 0.13 ng/ml (0.05-1.60), 0.11 ng/ml (0.04-3.54), 0.08 ng/ml (0.03-8.21), 0.11 ng/ml (0.02-2.64), 0.36 ng/ml (0.10-7.75), p<0.05, respectively, cut off value: 0.05 ng/ml) compared to those in non-febrile neutropenic patients (0.175 ng/ml (0.06-1.91): median (range), respectively), and CRP (Day 0, 2, 4, 7, 14 and 21) was also elevated (5.07 mg/dl (0.19-27.83), 3.19 mg/dl (0.30-20.54), 2.26 mg/dl (0.15-34.01), 1.33 mg/dl (0.10-29.48), 0.28 mg/dl (0.10-22.49), 0.36 mg/dl (0.10-7.75), p<0.05, respectively, cut off value: 0.3 mg/dl) compared to those in non-febrile neutropenic patients (0.625 mg/dl (0.11-8.72): median (range), respectively). There was no relation between Pre-SEP value and bacterial examination data including blood cultures. Almost FN cases responded empirical antibacterial therapy, and elevated Pre-SEP, PCT and CRP values decreased again accompanied by defervescence. However, some cases of persistent remarkably elevated Pre-SEP cases ware observed, and these cases had very poor prognosis. The 5 of 9 cases with remarkably high Pre-SEP value (>1000 pg/ml) at both day7 and 14, or both day14 and 21 were dead by severe infection related events within 4 weeks, otherwise all other 56 cases than the above recovered from infection events and survived (p<0.05, respectively).
Conclusion
These data suggested that Pre-SEP is elevated due to active infection events in FN patients in spite of conditions being remarkably decreased neutrophil and monocyte. Pre-SEP is useful as a biomarker of infection in FN patients, as well as PCT or CRP.
Session topic: E-poster
Keyword(s): Febrile neutropenia, Hematological malignancy, Infection, Neutrophil
Abstract: E1178
Type: Eposter Presentation
Background
ebrile neutropenia (FN) is often observed in patients with hematological malignancy (HEM). Most of causes are bacterial infections in these FN, and many cases respond to empirical antibiotic therapy including an anti-pseudomonas b-lactam agent. Otherwise, it is often difficult to specify the focus and pathogen of infection in FN patients. Presepsin (Pre-SEP) is a subtype of soluble CD14, which is a receptor for lipopolysaccharide (LPS)/LPS-binding protein complexes and is expressed on the myelo-monocytic cell surface. Recently, it has been shown to be a useful biomarker for assessing the severity of sepsis and has come into use in the field of critical care medicine. However, little is known about the biological characteristics of Pre-SEP in FN patients.
Aims
To clarify the usefulness of new biomarker Pre-SEP in the setting of neutropenia, we performed analyses to determine the clinical relevance of Pre-SEP in the diagnosis of bacteremia or other infectious complications as a biomarker for FN patients after or during chemotherapy in HEM.
Methods
We measured the plasma concentration of Pre-SEP, procalcitonin (PCT) and C-reactive protein (CRP) at Day0, 2, 4, 7, 14 and 21 after the onset of FN, and compared them to those of non-febrile neutropenic patients. Furthermore we reviewed other clinical data including bacterial examination and clinical courses, and evaluated the utility of Pre-SEP as biomarker of FN.
Results
The 65 hospitalized FN patients with HEM (AML 16, ALL 12, MDS 14, NHL 13, MM 8, and ATL 2) were treated by IDSA guideline and administered antibacterial or antifungal agents, and the clinical data including Pre-SEP were evaluated. Pre-SEP (Day 0, 2, 4, 7, 14 and 21) was elevated (447 pg/ml (141-2204), 494 pg/ml (151-1975), 344 pg/ml (164-1264), 312 pg/ml (116-1512), 319 pg/ml (86-1512), 278 pg/ml (129-1425), p<0.05, respectively, cut off value: 314 pg/ml) compared to those in non-febrile neutropenic patients (196 pg/ml (97.5-453): median (range), respectively). Otherwise, PCT (Day 0, 2, 4, 7, 14 and 21) was also elevated (0.12 ng/ml (0.04-3.40), 0.13 ng/ml (0.05-1.60), 0.11 ng/ml (0.04-3.54), 0.08 ng/ml (0.03-8.21), 0.11 ng/ml (0.02-2.64), 0.36 ng/ml (0.10-7.75), p<0.05, respectively, cut off value: 0.05 ng/ml) compared to those in non-febrile neutropenic patients (0.175 ng/ml (0.06-1.91): median (range), respectively), and CRP (Day 0, 2, 4, 7, 14 and 21) was also elevated (5.07 mg/dl (0.19-27.83), 3.19 mg/dl (0.30-20.54), 2.26 mg/dl (0.15-34.01), 1.33 mg/dl (0.10-29.48), 0.28 mg/dl (0.10-22.49), 0.36 mg/dl (0.10-7.75), p<0.05, respectively, cut off value: 0.3 mg/dl) compared to those in non-febrile neutropenic patients (0.625 mg/dl (0.11-8.72): median (range), respectively). There was no relation between Pre-SEP value and bacterial examination data including blood cultures. Almost FN cases responded empirical antibacterial therapy, and elevated Pre-SEP, PCT and CRP values decreased again accompanied by defervescence. However, some cases of persistent remarkably elevated Pre-SEP cases ware observed, and these cases had very poor prognosis. The 5 of 9 cases with remarkably high Pre-SEP value (>1000 pg/ml) at both day7 and 14, or both day14 and 21 were dead by severe infection related events within 4 weeks, otherwise all other 56 cases than the above recovered from infection events and survived (p<0.05, respectively).
Conclusion
These data suggested that Pre-SEP is elevated due to active infection events in FN patients in spite of conditions being remarkably decreased neutrophil and monocyte. Pre-SEP is useful as a biomarker of infection in FN patients, as well as PCT or CRP.
Session topic: E-poster
Keyword(s): Febrile neutropenia, Hematological malignancy, Infection, Neutrophil
Type: Eposter Presentation
Background
ebrile neutropenia (FN) is often observed in patients with hematological malignancy (HEM). Most of causes are bacterial infections in these FN, and many cases respond to empirical antibiotic therapy including an anti-pseudomonas b-lactam agent. Otherwise, it is often difficult to specify the focus and pathogen of infection in FN patients. Presepsin (Pre-SEP) is a subtype of soluble CD14, which is a receptor for lipopolysaccharide (LPS)/LPS-binding protein complexes and is expressed on the myelo-monocytic cell surface. Recently, it has been shown to be a useful biomarker for assessing the severity of sepsis and has come into use in the field of critical care medicine. However, little is known about the biological characteristics of Pre-SEP in FN patients.
Aims
To clarify the usefulness of new biomarker Pre-SEP in the setting of neutropenia, we performed analyses to determine the clinical relevance of Pre-SEP in the diagnosis of bacteremia or other infectious complications as a biomarker for FN patients after or during chemotherapy in HEM.
Methods
We measured the plasma concentration of Pre-SEP, procalcitonin (PCT) and C-reactive protein (CRP) at Day0, 2, 4, 7, 14 and 21 after the onset of FN, and compared them to those of non-febrile neutropenic patients. Furthermore we reviewed other clinical data including bacterial examination and clinical courses, and evaluated the utility of Pre-SEP as biomarker of FN.
Results
The 65 hospitalized FN patients with HEM (AML 16, ALL 12, MDS 14, NHL 13, MM 8, and ATL 2) were treated by IDSA guideline and administered antibacterial or antifungal agents, and the clinical data including Pre-SEP were evaluated. Pre-SEP (Day 0, 2, 4, 7, 14 and 21) was elevated (447 pg/ml (141-2204), 494 pg/ml (151-1975), 344 pg/ml (164-1264), 312 pg/ml (116-1512), 319 pg/ml (86-1512), 278 pg/ml (129-1425), p<0.05, respectively, cut off value: 314 pg/ml) compared to those in non-febrile neutropenic patients (196 pg/ml (97.5-453): median (range), respectively). Otherwise, PCT (Day 0, 2, 4, 7, 14 and 21) was also elevated (0.12 ng/ml (0.04-3.40), 0.13 ng/ml (0.05-1.60), 0.11 ng/ml (0.04-3.54), 0.08 ng/ml (0.03-8.21), 0.11 ng/ml (0.02-2.64), 0.36 ng/ml (0.10-7.75), p<0.05, respectively, cut off value: 0.05 ng/ml) compared to those in non-febrile neutropenic patients (0.175 ng/ml (0.06-1.91): median (range), respectively), and CRP (Day 0, 2, 4, 7, 14 and 21) was also elevated (5.07 mg/dl (0.19-27.83), 3.19 mg/dl (0.30-20.54), 2.26 mg/dl (0.15-34.01), 1.33 mg/dl (0.10-29.48), 0.28 mg/dl (0.10-22.49), 0.36 mg/dl (0.10-7.75), p<0.05, respectively, cut off value: 0.3 mg/dl) compared to those in non-febrile neutropenic patients (0.625 mg/dl (0.11-8.72): median (range), respectively). There was no relation between Pre-SEP value and bacterial examination data including blood cultures. Almost FN cases responded empirical antibacterial therapy, and elevated Pre-SEP, PCT and CRP values decreased again accompanied by defervescence. However, some cases of persistent remarkably elevated Pre-SEP cases ware observed, and these cases had very poor prognosis. The 5 of 9 cases with remarkably high Pre-SEP value (>1000 pg/ml) at both day7 and 14, or both day14 and 21 were dead by severe infection related events within 4 weeks, otherwise all other 56 cases than the above recovered from infection events and survived (p<0.05, respectively).
Conclusion
These data suggested that Pre-SEP is elevated due to active infection events in FN patients in spite of conditions being remarkably decreased neutrophil and monocyte. Pre-SEP is useful as a biomarker of infection in FN patients, as well as PCT or CRP.
Session topic: E-poster
Keyword(s): Febrile neutropenia, Hematological malignancy, Infection, Neutrophil
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