Contributions
Abstract: PB2060
Type: Publication Only
Background
Febrile neutropenia (FN) is one of the most common complications in patients with hematological malignancies which is caused by chemotherapy and the underlying disease. C-reactive protein (CRP) and procalcitonin (PCT) have been used as diagnostic markers of infections but they have some limitations. Recently, soluble CD14 subtype (sCD14-ST), also known as presepsin was reported as a novel and promising biomarker for the diagnosis of sepsis. However, its usefulness in identifying infections in patients with hematological malignancies during episodes of fever and neutropenia remains unclear.
Aims
The aim of this study was to evaluate the usefulness of presepsin compared to CRP and PCT as an early diagnostic marker of infections in FN patients with hematological malignancies.
Methods
In addition to blood cultures, we have measured presepsin, CRP and PCT, in 60 individuals. 30 of them were pediatric patients with hematological malignancies during episodes of fever and neutropenia (serving as patients group) and the other 30 were apparently healthy age and sex matched individuals (serving as control group), all of them participated in the study after consent of their relatives. patients were subclassified into 3 subgroups (patients with fever of unknown origin (FUO), patients with bacteremia, patients with clinically proved infections in the form of mucositis, pneumonia, urinary tract infection, neutrpenic enterocolitis). The sensitivity and specificity of the three biomarkers were compared in the 3 subgroups.
Results
Prespsin levels were significantly higher in bacteremia patients than those with FUO and clinically proved infections. In contrast CRP levels didn't show significant increase in bacteremia patients than those with clinically proved infections, also PCT levels were not significantly higher in clinically proved infections patients than FUO patients.
Our study showed that there were slight elevation in presepsin levels in gram negative cultures than in gram positive cultures but this rise was not statistically significant.
This study also showed that there was statistically significant negative correlation between presepsin and absolute neutrophil count (ANC) which also correlates with the severity of infections.
The reliability of presepsin was higher than that of PCT and CRP in prediction of bacteremia in FN patients where the sensitivity of presepsin ,PCT and CRP was (100%, 100%, 77.8% respectively),and the specificity was (85.7%, 81%, 66.7% respectively).
Presepsin was also superior to CRP and PCT in identification of bacterial infections either in the form of bacteremia or clinically proved infections with sensitivity (100%, 100%, 68.8% respectively) and specificity (100%, 64.3%, 85.7% respectively).
Conclusion
Presepsin can be used as a discriminator of infectious and non infectious origin of fever in FN patients with hematological malignancies even with very low total leucocyte count and ANC due to chemotherapy. The combination of presepsin and CRP may improve the sensitivity and specificity for prediction of bacterial infections in those patients.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Febrile neutropenia, Hematological malignancy, Infection
Abstract: PB2060
Type: Publication Only
Background
Febrile neutropenia (FN) is one of the most common complications in patients with hematological malignancies which is caused by chemotherapy and the underlying disease. C-reactive protein (CRP) and procalcitonin (PCT) have been used as diagnostic markers of infections but they have some limitations. Recently, soluble CD14 subtype (sCD14-ST), also known as presepsin was reported as a novel and promising biomarker for the diagnosis of sepsis. However, its usefulness in identifying infections in patients with hematological malignancies during episodes of fever and neutropenia remains unclear.
Aims
The aim of this study was to evaluate the usefulness of presepsin compared to CRP and PCT as an early diagnostic marker of infections in FN patients with hematological malignancies.
Methods
In addition to blood cultures, we have measured presepsin, CRP and PCT, in 60 individuals. 30 of them were pediatric patients with hematological malignancies during episodes of fever and neutropenia (serving as patients group) and the other 30 were apparently healthy age and sex matched individuals (serving as control group), all of them participated in the study after consent of their relatives. patients were subclassified into 3 subgroups (patients with fever of unknown origin (FUO), patients with bacteremia, patients with clinically proved infections in the form of mucositis, pneumonia, urinary tract infection, neutrpenic enterocolitis). The sensitivity and specificity of the three biomarkers were compared in the 3 subgroups.
Results
Prespsin levels were significantly higher in bacteremia patients than those with FUO and clinically proved infections. In contrast CRP levels didn't show significant increase in bacteremia patients than those with clinically proved infections, also PCT levels were not significantly higher in clinically proved infections patients than FUO patients.
Our study showed that there were slight elevation in presepsin levels in gram negative cultures than in gram positive cultures but this rise was not statistically significant.
This study also showed that there was statistically significant negative correlation between presepsin and absolute neutrophil count (ANC) which also correlates with the severity of infections.
The reliability of presepsin was higher than that of PCT and CRP in prediction of bacteremia in FN patients where the sensitivity of presepsin ,PCT and CRP was (100%, 100%, 77.8% respectively),and the specificity was (85.7%, 81%, 66.7% respectively).
Presepsin was also superior to CRP and PCT in identification of bacterial infections either in the form of bacteremia or clinically proved infections with sensitivity (100%, 100%, 68.8% respectively) and specificity (100%, 64.3%, 85.7% respectively).
Conclusion
Presepsin can be used as a discriminator of infectious and non infectious origin of fever in FN patients with hematological malignancies even with very low total leucocyte count and ANC due to chemotherapy. The combination of presepsin and CRP may improve the sensitivity and specificity for prediction of bacterial infections in those patients.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Febrile neutropenia, Hematological malignancy, Infection