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异基因造血干细胞移植中的早期发热:可溶性髓系细胞触发受体-1和YKL-40是有价值的诊断工具吗?

Early Fever in Allogeneic Stem Cell Transplantation: Are Presepsin and YKL-40 Valuable Diagnostic Tools?

作者信息

Babel Jakša, Košuta Iva, Vujaklija Brajković Ana, Lončar Vrančić Ana, Premužić Vedran, Rogić Dunja, Duraković Nadira

机构信息

Division of Intensive Care Medicine, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia.

School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.

出版信息

J Clin Med. 2024 Oct 8;13(19):5991. doi: 10.3390/jcm13195991.

Abstract

: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a lifesaving treatment but carries a high infection risk. Diagnosing infections remains challenging due to the limited accuracy of standard biomarkers. : This single-center study aimed to evaluate presepsin (PSP) and YKL-40 as infection biomarkers in febrile patients during the allo-HSCT pre-engraftment phase. Biomarker levels were prospectively measured in 61 febrile episodes from 54 allo-HSCT patients at admission, representing baseline levels, and then at Day 1, 3, 5, and 7 following fever onset. The diagnostic value was compared to that of procalcitonin (PCT). : PSP showed fair diagnostic value on Day 1 (AUC 0.656; 95% CI: 0.510-0.802) and Day 3 (AUC 0.698; 95% CI: 0.559-0.837). YKL-40 did not provide any significant diagnostic value across measured time points. PCT outperformed PSP and YKL-40, particularly on Day 3 (AUC 0.712; 95% CI: 0.572-0.852). When combining biomarkers, the best model for predicting infection used PSP > 3.144 ng/mL and PCT > 0.28 μg/L on Day 3, resulting in R of about 31% ( < 0.001). : Neither test showed sufficient discriminative power for early infection to recommend their use as individual diagnostic tools in clinical practice.

摘要

异基因造血干细胞移植(allo-HSCT)是一种挽救生命的治疗方法,但感染风险很高。由于标准生物标志物的准确性有限,感染的诊断仍然具有挑战性。本单中心研究旨在评估 presepsin(PSP)和 YKL-40 作为 allo-HSCT 植入前阶段发热患者感染生物标志物的情况。前瞻性地测量了 54 例 allo-HSCT 患者 61 次发热发作入院时的生物标志物水平,即基线水平,然后在发热发作后的第 1、3、5 和 7 天进行测量。将诊断价值与降钙素原(PCT)进行比较。PSP 在第 1 天(AUC 0.656;95%CI:0.510 - 0.802)和第 3 天(AUC 0.698;95%CI:0.559 - 0.837)显示出一定的诊断价值。YKL-40 在所有测量时间点均未提供任何显著的诊断价值。PCT 的表现优于 PSP 和 YKL-40,尤其是在第 3 天(AUC 0.712;95%CI:0.572 - 0.852)。当联合使用生物标志物时,预测感染的最佳模型是第 3 天 PSP > 3.144 ng/mL 且 PCT > 0.28 μg/L,其 R 约为 31%(<0.001)。两种检测方法对于早期感染均未显示出足够的鉴别能力,因此不建议在临床实践中将其作为单独的诊断工具使用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e38/11478026/2138f9eafa4f/jcm-13-05991-g001a.jpg

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本文引用的文献

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