Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Bone Marrow Transplant. 2012 Oct;47(10):1326-31. doi: 10.1038/bmt.2012.18. Epub 2012 Feb 20.
Infectious disease following hematopoietic SCT (HSCT) is a major cause of TRM. The more valuable markers to distinguish infections disease from non-infectious complications are needed. Procalcitonin (PCT) and C-reactive protein (CRP) were measured periodically throughout the clinical course of consecutive 28 patients who underwent HSCT. The diagnoses of 103 febrile episodes were analyzed. PCT and CRP level on the first day of fever significantly increased in systemic bacterial or fungal infection (P<0.001 and <0.001, respectively). PCT is more valuable than CRP for discrimination between systemic bacterial or fungal infection and intracellular infection (P=0.022 and 0.447, respectively). The area under receiver-operator characteristics curve for detection of bacterial or fungal infection was 0.82 for PCT and 0.76 for CRP. When PCT levels did not increase over 0.25 ng/mL through the fifth day of fever, PCT yielded a specificity of 100.0%. In multivariate analysis, the maximum level of PCT during a whole course of HSCT>=2 ng/mL was independently associated with worse overall survival as post-transplant predictors (adjusted hazard ratio 6.42, P=0.035). PCT provide additional information for discrimination between bacterial or fungal infection and other causes and predicting the patient's prognosis after HSCT.
造血干细胞移植（HSCT）后感染是治疗相关死亡率（TRM）的主要原因。需要更有价值的标志物来区分感染和非感染性并发症。连续 28 例接受 HSCT 的患者在整个临床过程中定期测量降钙素原（PCT）和 C 反应蛋白（CRP）。分析了 103 例发热病例。全身细菌或真菌感染患者的 PCT 和 CRP 水平在发热的第一天明显升高（P<0.001 和 <0.001）。PCT 比 CRP 更有助于区分全身细菌或真菌感染与细胞内感染（P=0.022 和 0.447）。PCT 检测细菌或真菌感染的受试者工作特征曲线下面积为 0.82，CRP 为 0.76。当发热第 5 天 PCT 水平未升高超过 0.25ng/mL 时，PCT 的特异性为 100.0%。多因素分析显示，整个 HSCT 过程中 PCT 的最高水平>=2ng/mL 是与移植后总体生存不良相关的独立预测因素（调整后的危险比为 6.42，P=0.035）。PCT 提供了区分细菌或真菌感染与其他原因的额外信息，并预测了 HSCT 后患者的预后。
