Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Immunol. 2022 Apr 25;13:843067. doi: 10.3389/fimmu.2022.843067. eCollection 2022.
The diagnostic value of procalcitonin and the prognostic role of PCT clearance remain unclear in neutropenic period after allogeneic hematopoietic stem cell transplantation introduction. This study evaluated 219 febrile neutropenic patients (116, retrospectively; 103, prospectively) who underwent allo-HSCT from April 2014 to March 2016. The area under the receiver operator characteristic curve (AUC) of PCT for detecting documented infection (DI) was 0.637, and that of bloodstream infection (BSI) was 0.811. In multivariate analysis, the inability to decrease PCT by more than 80% within 5-7 days after the onset of fever independently predicted poor 100-day survival following allo-HSCT (P = 0.036). Furthermore, the prognostic nomogram combining PCTc and clinical parameters showed a stable predictive performance, supported by the C-index of 0.808 and AUC of 0.813 in the primary cohort, and C-index of 0.691 and AUC of 0.697 in the validation cohort. This study demonstrated the diagnostic role of PCT in documented and bloodstream infection during the neutropenic period after allo-HSCT. PCTc might serve as a predictive indicator of post-HSCT 100-day mortality. A nomogram based on PCTc and several clinical factors effectively predicted the 100-day survival of febrile patients and may help physicians identify high-risk patients in the post-HSCT neutropenic period.
在异基因造血干细胞移植引入后中性粒细胞减少期，降钙素原的诊断价值和 PCT 清除率的预后作用仍不清楚。本研究评估了 219 例于 2014 年 4 月至 2016 年 3 月期间接受异基因 HSCT 的发热性中性粒细胞减少症患者（116 例回顾性，103 例前瞻性）。PCT 检测确诊感染（DI）的受试者工作特征曲线（ROC）下面积（AUC）为 0.637，血流感染（BSI）为 0.811。多变量分析显示，发热后 5-7 天内 PCT 不能降低 80%以上与异基因 HSCT 后 100 天的生存不良独立相关（P=0.036）。此外，结合 PCTc 和临床参数的预后列线图显示出稳定的预测性能，在原始队列中的 C 指数为 0.808，AUC 为 0.813，验证队列中的 C 指数为 0.691，AUC 为 0.697。本研究表明 PCT 在异基因 HSCT 后中性粒细胞减少期诊断 DI 和 BSI 中的作用。PCTc 可能是 HSCT 后 100 天死亡率的预测指标。基于 PCTc 和几个临床因素的列线图有效地预测了发热患者的 100 天生存率，可能有助于医生在 HSCT 后中性粒细胞减少期识别高危患者。
