Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
Crit Care Med. 2011 May;39(5):993-9. doi: 10.1097/CCM.0b013e31820a92dc.
To assess the value of soluble triggering receptor expressed on myeloid cells-1 as a biomarker of infection in patients with neutropenic fever comparing with procalcitonin and C-reactive protein.
Prospective, comparative, single-center study.
Hematology ward at a university hospital.
Seventy-five patients with neutropenic fever after chemotherapy for their hematologic malignancies.
None.
A total of 137 episodes of neutropenic fever in 75 patients were classified into 75 episodes of documented infections and 62 low likelihood of infection. The level of soluble triggering receptor expressed on myeloid cells-1 was significantly elevated in the group of documented infection. The area under the receiver operating characteristic curve for the diagnosis of infection was 0.719 (95% confidence interval, 0.632-0.806; p < .0001) for soluble triggering receptor expressed on myeloid cells-1, which was larger than the values of 0.501 for procalcitonin (0.465-0.657; p = .218) and 0.491 for C-reactive protein (0.394-0.589, p = .858). The fitted marginal logistic regression model of all episodes contained two statistically significant predictors of infection: soluble triggering receptor expressed on myeloid cells-1 (per 1-pg/mL increase; odds ratio [OR], 1.0002; 95% CI, 1.0001-1.0003; p < .0001) and procalcitonin (per 1-ng/mL increase; OR, 1.0094; 95% CI, 1.0005-1.0184; p = .0002). In a diagnostic panel with soluble triggering receptor expressed on myeloid cells-1 and procalcitonin, the sensitivity and specificity were 88% and 48%, respectively.
Soluble triggering receptor expressed on myeloid cells-1 is better than procalcitonin in the prediction of infection at the onset of neutropenic fever. By applying soluble triggering receptor expressed on myeloid cells-1 and procalcitonin together, low or high risk for infection can be defined at the onset of neutropenic fever.
评估髓系细胞触发受体-1 可溶性蛋白作为中性粒细胞减少性发热患者感染生物标志物的价值，并与降钙素原和 C 反应蛋白进行比较。
前瞻性、对照、单中心研究。
某大学医院血液科病房。
75 例因血液系统恶性肿瘤接受化疗后出现中性粒细胞减少性发热的患者。
无。
75 例患者共发生 137 次中性粒细胞减少性发热，其中 75 次为确诊感染，62 次为低度感染可能。确诊感染组可溶性髓系细胞触发受体-1 水平显著升高。诊断感染的受试者工作特征曲线下面积为 0.719（95%置信区间，0.632-0.806；P＜0.0001），降钙素原的曲线下面积为 0.501（0.465-0.657；P=0.218），C 反应蛋白的曲线下面积为 0.491（0.394-0.589，P=0.858）。所有发作的拟合边际逻辑回归模型包含感染的两个有统计学意义的预测因子：可溶性髓系细胞触发受体-1（每增加 1-pg/mL；比值比[OR]，1.0002；95%置信区间，1.0001-1.0003；P＜0.0001）和降钙素原（每增加 1-ng/mL；OR，1.0094；95%置信区间，1.0005-1.0184；P=0.0002）。在包含可溶性髓系细胞触发受体-1 和降钙素原的诊断面板中，敏感性和特异性分别为 88%和 48%。
在中性粒细胞减少性发热发作时，可溶性髓系细胞触发受体-1 比降钙素原更能预测感染。通过联合应用可溶性髓系细胞触发受体-1 和降钙素原，可以在中性粒细胞减少性发热发作时确定感染的低风险或高风险。
