García de Guadiana-Romualdo Luis, Español-Morales Ignacio, Cerezuela-Fuentes Pablo, Consuegra-Sánchez Luciano, Hernando-Holgado Ana, Esteban-Torrella Patricia, Jiménez-Santos Enrique, Viqueira-González Monserrat, de Béjar-Almira África, Albaladejo-Otón María Dolores
Biochemistry Department, Hospital Universitario Santa Lucía, Calle Mezquita s/n. Paraje Los Arcos, 30202, Cartagena, Murcia, Spain,
Support Care Cancer. 2015 Jul;23(7):2175-82. doi: 10.1007/s00520-014-2589-1. Epub 2015 Jan 7.
Early detection of infection is essential for initial management of cancer patients with chemotherapy-associated febrile neutropenia in the emergency department. In this study, we evaluated lipopolysaccharide binding protein (LBP) as predictor for infection in febrile neutropenia and compared with other biomarkers previously studied: C-reactive protein (CRP), procalcitonin (PCT), and interleukin (IL)-6.
A total of 61 episodes of chemotherapy-associated febrile neutropenia in 58 adult cancer patients were included. Serum samples were collected on admission at emergency department and CRP, LBP, PCT, and IL-6 were measured. Patients were classified into fever of unknown origin and infection, including microbiologically and clinically documented infection, groups. Receiver operating characteristic (ROC) curve analysis was performed for each biomarker for the diagnosis of infection.
Thirty-two of the 61 episodes were classified as infection. On admission, CRP, PCT, IL-6, and LBP were significantly increased in patients with infection compared to fever of unknown origin group. Area under the ROC curve (AUC ROC) of CRP, PCT, IL-6, and LBP for discriminating both groups was 0.77, 0.88, 0.82, and 0.82, respectively, without significant difference between them. The combination of IL-6 and PCT or LBP did not lead to a significant improvement of the diagnostic accuracy of PCT or LBP alone.
On admission, LBP has a similar diagnostic accuracy than PCT or IL-6 for the diagnosis of infection and might be used as additional diagnostic tool in adult cancer patients with chemotherapy-associated febrile neutropenia.
早期发现感染对于急诊室中癌症化疗相关发热性中性粒细胞减少症患者的初始治疗至关重要。在本研究中，我们评估了脂多糖结合蛋白（LBP）作为发热性中性粒细胞减少症感染预测指标，并与先前研究的其他生物标志物进行比较：C反应蛋白（CRP）、降钙素原（PCT）和白细胞介素（IL）-6。
纳入58例成年癌症患者共61次化疗相关发热性中性粒细胞减少症发作。在急诊室入院时采集血清样本，检测CRP、LBP、PCT和IL-6。患者分为不明原因发热组和感染组，后者包括微生物学和临床确诊感染组。对每种生物标志物进行诊断感染的受试者工作特征（ROC）曲线分析。
61次发作中有32次被归类为感染。入院时，与不明原因发热组相比，感染患者的CRP、PCT、IL-6和LBP显著升高。CRP、PCT、IL-6和LBP区分两组的ROC曲线下面积（AUC ROC）分别为0.77、0.88、0.82和0.82，它们之间无显著差异。IL-6与PCT或LBP联合使用并未显著提高单独使用PCT或LBP的诊断准确性。
入院时，LBP在诊断感染方面与PCT或IL-6具有相似的诊断准确性，可作为成年癌症化疗相关发热性中性粒细胞减少症患者的额外诊断工具。
