Michel C S, Teschner D, Wagner E M, Theobald M, Radsak Markus P
Department of Hematology, Medical Oncology, & Pneumology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr.1, 55130, Mainz, Germany.
Ann Hematol. 2017 Dec;96(12):2095-2101. doi: 10.1007/s00277-017-3128-1. Epub 2017 Sep 17.
Infections and infectious complications are the major cause of morbidity and mortality in febrile neutropenic patients after autologous stem cell transplantation. Laboratory biomarkers are helpful for early identification of critically ill patients and optimal therapy management. Several studies in adult non-neutropenic patients proposed sTREM-1 as a superior biomarker for identification of septic patients as well as a predictor for survival in these patients compared with procalcitonin (PCT), C-reactive protein (CRP), or interleukin-8 (IL-8). Here, to assess the utility of PCT, CRP, IL-8, and sTREM-1 in febrile neutropenia, 44 patients presenting with febrile neutropenia after autologous stem cell transplantation were recruited in a single-center prospective pilot study. We analyzed PCT and CRP as well as IL-8 and sTREM-1 levels pre- and post-transplantation at defined time points. In 20 of 44 patients, concentration of sTREM-1 was under the detection level at appearance of febrile neutropenia. Mean levels of PCT, IL-8, and CRP were significantly increased in infections of critically ill patients who by dysfunction or failure of one or more organs/system depend on survival from advanced instruments of monitoring and therapy. However, all tested biomarkers could not distinguish between presence and absence of bloodstream infection. The combination of the biomarkers PCT and IL-8 achieved a high sensitivity of 90% and specificity of 74% for the identification of serious complications in febrile neutropenia, whereas the combination of CRP and PCT or IL-8 achieved a high sensitivity of 100%, but with the addition of a low specificity of 47or 41%. In conclusion, we found that the measurement of sTREM-1 concentration at presentation of febrile neutropenia is not useful to identify bacterial bloodstream infections and critically ill patients. PCT and IL-8 are useful biomarkers for the early identification of critically ill patients, compared to CRP and sTREM-1 in febrile neutropenia. PCT or IL-8 in combination with clinical parameters should be considered in routine measurement to identify critically ill patients as early as possible.
感染及感染性并发症是自体干细胞移植后发热性中性粒细胞减少患者发病和死亡的主要原因。实验室生物标志物有助于早期识别危重症患者并进行最佳治疗管理。多项针对成年非中性粒细胞减少患者的研究表明，与降钙素原（PCT）、C反应蛋白（CRP）或白细胞介素-8（IL-8）相比，可溶性髓系细胞触发受体-1（sTREM-1）是识别脓毒症患者的更优生物标志物，也是这些患者生存的预测指标。在此，为评估PCT、CRP、IL-8和sTREM-1在发热性中性粒细胞减少中的作用，一项单中心前瞻性试点研究纳入了44例自体干细胞移植后出现发热性中性粒细胞减少的患者。我们在特定时间点分析了移植前后的PCT、CRP以及IL-8和sTREM-1水平。44例患者中有20例在出现发热性中性粒细胞减少时sTREM-1浓度低于检测水平。在因一个或多个器官/系统功能障碍或衰竭而依赖先进监测和治疗手段生存的危重症患者感染中，PCT、IL-8和CRP的平均水平显著升高。然而，所有检测的生物标志物均无法区分是否存在血流感染。生物标志物PCT和IL-8联合使用时，识别发热性中性粒细胞减少严重并发症的灵敏度高达90%，特异性为74%；而CRP与PCT或IL-8联合使用时，灵敏度高达100%，但特异性较低，分别为47%或41%。总之，我们发现发热性中性粒细胞减少时测定sTREM-1浓度对识别细菌血流感染和危重症患者并无帮助。在发热性中性粒细胞减少中，与CRP和sTREM-1相比，PCT和IL-8是早期识别危重症患者的有用生物标志物。在常规检测中应考虑将PCT或IL-8与临床参数结合，以尽早识别危重症患者。
