Oude Nijhuis Claudi S M, Vellenga Edo, Daenen Simon M G J, van der Graaf Winette T A, Gietema Jourik A, Groen Harry J M, Kamps Willem A, de Bont Eveline S J M
Division of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Hospital Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Division of Hematology, Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands.
Intensive Care Med. 2003 Dec;29(12):2157-2161. doi: 10.1007/s00134-003-2026-2. Epub 2003 Oct 16.
Cancer patients with febrile neutropenia after chemotherapy have a variable risk of bacterial infection. Especially Gram-negative bacteremia is associated with high mortality and/or morbidity. Early diagnosis of patients with Gram-negative bacteremia at the onset of febrile neutropenia is potentially useful in tailoring therapy.
Prospective study at the Department of Pediatric Oncology and Internal Medicine of a university hospital.
Were analyzed 66 febrile neutropenic episodes in 57 adults and children. Patients were divided into four groups: those with Gram-negative bacteremia, Gram-positive bacteremia, clinical sepsis, or fever of unknown origin.
Plasma lipopolysaccharide-binding protein (LBP) and C-reactive protein (CRP) concentrations were determined. LBP at the onset of febrile neutropenia was significantly higher in patients with Gram-negative bacteremia than those with fever of unknown origin and those with Gram-positive bacteremia. Using a cutoff value for LBP proved to have much greater sensitivity, specificity, and positive and negative predictive value for Gram-negative bacteremia than the best cutoff value for CRP.
An initial high LBP level might predict Gram-negative bacteremia in cancer patients with febrile neutropenia. These results may have potential clinical impact by allowing therapy to be initiated for these patients at a very early stage.
化疗后出现发热性中性粒细胞减少的癌症患者发生细菌感染的风险各不相同。尤其是革兰氏阴性菌血症与高死亡率和/或高发病率相关。在发热性中性粒细胞减少症发作时对革兰氏阴性菌血症患者进行早期诊断可能有助于调整治疗方案。
在一所大学医院的儿科肿瘤学和内科进行的前瞻性研究。
分析了57名成人和儿童的66次发热性中性粒细胞减少发作。患者分为四组：革兰氏阴性菌血症组、革兰氏阳性菌血症组、临床脓毒症组或不明原因发热组。
测定血浆脂多糖结合蛋白（LBP）和C反应蛋白（CRP）浓度。发热性中性粒细胞减少症发作时，革兰氏阴性菌血症患者的LBP显著高于不明原因发热患者和革兰氏阳性菌血症患者。与CRP的最佳临界值相比，LBP临界值对革兰氏阴性菌血症具有更高的敏感性、特异性、阳性预测值和阴性预测值。
初始LBP水平较高可能预示发热性中性粒细胞减少的癌症患者发生革兰氏阴性菌血症。这些结果可能会在极早期就开始对这些患者进行治疗，从而产生潜在的临床影响。
