分析 PSP、PCT 和 sCD25 在诊断发热性中性粒细胞减少症癌症患者感染中的作用。

Analyzing the capability of PSP, PCT and sCD25 to support the diagnosis of infection in cancer patients with febrile neutropenia.

机构信息

Clinical Chemistry Laboratory, Santa Lucía University Hospital, Avenida Génova 196, Cartagena 30319, Spain, Phone: +34 636 68 32 80.

Clinical Chemistry Laboratory, Santa Lucía University Hospital, Cartagena, Spain.

出版信息

Clin Chem Lab Med. 2019 Mar 26;57(4):540-548. doi: 10.1515/cclm-2018-0154.

DOI:10.1515/cclm-2018-0154

PMID:30240355

Abstract

Background Early diagnosis of infection is essential for the initial management of cancer patients with chemotherapy-associated febrile neutropenia (FN). In this study, we have evaluated two emerging infection biomarkers, pancreatic stone protein (PSP) and soluble receptor of interleukin 2, known as soluble cluster of differentiation 25 (sCD25), for the detection of an infectious cause in FN, in comparison with other commonly used infection biomarkers, such as procalcitonin (PCT). Methods A total of 105 cancer patients presenting to the emergency department were prospectively enrolled. We observed 114 episodes of chemotherapy-associated FN. At presentation, a blood sample was collected for the measurement of PCT, PSP and sCD25. In order to evaluate the discriminatory ability of these markers for the diagnosis of infection, the area under the curve (AUC) of the receiver operating characteristic curves was calculated. Results Infection was documented in 59 FN episodes. PCT, PSP and sCD25 levels were significantly higher in infected patients. PCT was the biomarker with the highest diagnostic accuracy for infection (AUC: 0.901), whereas PSP and sCD25 showed a similar performance, with AUCs of 0.751 and 0.730, respectively. In a multivariable analysis, PCT and sCD25 were shown to be independently associated with infection. Conclusions Two novel biomarkers, PSP and sCD25, correlated with infection in cancer patients with chemotherapy-associated FN, but neither PSP nor sCD25 improved the performance of PCT. Based on the results obtained, the introduction of these novel biomarkers as a tool for the diagnosis of infection in this patient group is not recommended.

摘要

背景

对于接受化疗相关性发热性中性粒细胞减少症（FN）的癌症患者，早期诊断感染对于初始治疗至关重要。在这项研究中，我们评估了两种新兴的感染生物标志物，即胰腺结石蛋白（PSP）和白细胞介素 2 可溶性受体，也称为可溶性 CD25（sCD25），以检测 FN 中的感染原因，并与其他常用的感染生物标志物（如降钙素原（PCT））进行比较。

方法

前瞻性纳入了 105 例因 FN 就诊于急诊科的癌症患者。共观察到 114 例化疗相关性 FN 发作。在就诊时，采集血样以测量 PCT、PSP 和 sCD25。为了评估这些标志物对感染诊断的鉴别能力，计算了受试者工作特征曲线下的面积（AUC）。

结果

59 例 FN 发作中证实存在感染。感染患者的 PCT、PSP 和 sCD25 水平显著升高。PCT 是用于感染诊断的准确性最高的生物标志物（AUC：0.901），而 PSP 和 sCD25 的表现相似，AUC 分别为 0.751 和 0.730。在多变量分析中，PCT 和 sCD25 与感染独立相关。