Division of Hemato-Oncology, Department of Pediatrics, University Medical Center Ljubljana, Ljubljana, Slovenia,
Support Care Cancer. 2014 Jan;22(1):269-77. doi: 10.1007/s00520-013-1978-1. Epub 2013 Sep 21.
In febrile neutropenia (FN), no reliable marker has been identified to discriminate between severe infection and other causes of fever early in the clinical course. Since lipopolysaccharide-binding protein (LBP) has proven to be an accurate biomarker of bacteremia/clinical sepsis in critically ill non-immunocompromised infants and children, we performed a prospective study to determine the diagnostic accuracy of LBP in children with FN.
Concentrations of LBP, procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) were prospectively measured on two consecutive days in 90 FN episodes experienced by 47 children. Receiver operating characteristic curve analysis was performed for each biomarker to predict bacteremia/clinical sepsis and severe sepsis.
Eighteen of the 90 episodes were classified as bacteremia/clinical sepsis. On both days 1 and 2, all biomarkers had a low to intermediate diagnostic accuracy for sepsis, and no significant differences were found between them (area under the curve (AUC) for LBP, 0.648 and 0.714; for PCT, 0.665 and 0.744; for IL-6, 0.775 and 0.775; and for CRP, 0.695 and 0.828). Comparison of their AUCs to the AUC of maximum body temperature on admission (AUC = 0.668) also failed to show any significant differences. In severe sepsis, however, the best diagnostic accuracies were found for IL-6 and PCT (AUC 0.892 and 0.752, respectively), and these were significantly higher than those for LBP (AUC 0.566) on admission.
On admission and 24 h later, the LBP concentration is less accurate for predicting bacteremia/clinical sepsis compared to IL-6, PCT, and CRP.
在发热性中性粒细胞减少症（FN）中，尚未确定可靠的标志物来早期区分严重感染和其他发热原因。由于脂多糖结合蛋白（LBP）已被证明是危重非免疫功能低下婴儿和儿童菌血症/临床败血症的准确生物标志物，我们进行了一项前瞻性研究，以确定 LBP 在 FN 患儿中的诊断准确性。
对 47 名患儿的 90 例 FN 发作连续两天进行 LBP、降钙素原（PCT）、白细胞介素 6（IL-6）和 C 反应蛋白（CRP）浓度的前瞻性测量。为每个生物标志物进行了接收者操作特征曲线分析，以预测菌血症/临床败血症和严重败血症。
90 例发作中有 18 例被归类为菌血症/临床败血症。在第 1 天和第 2 天，所有生物标志物对败血症的诊断准确性均较低，且之间无显着差异（LBP 的曲线下面积（AUC）分别为 0.648 和 0.714；PCT 为 0.665 和 0.744；IL-6 为 0.775 和 0.775；CRP 为 0.695 和 0.828）。与入院时最高体温的 AUC 相比，比较它们的 AUC 也未显示出任何显着差异。然而，在严重败血症中，IL-6 和 PCT 的最佳诊断准确性最高（AUC 分别为 0.892 和 0.752），明显高于入院时的 LBP（AUC 为 0.566）。
入院时和 24 小时后，与 IL-6、PCT 和 CRP 相比，LBP 浓度预测菌血症/临床败血症的准确性较低。
