García-García Paola E, Palomo-Colli Miguel A, Silva-Jivaja Karla M, Juárez-Villegas Luis E, Vidal-Romero Gustavo, Sánchez-Rodríguez Martha A, Castelán-Martínez Osvaldo D
Clinical Pharmacology Laboratory, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City 09230, Mexico.
Department of Hemato-Oncology, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico.
Mol Clin Oncol. 2024 Dec 19;22(2):22. doi: 10.3892/mco.2024.2817. eCollection 2025 Feb.
Sepsis and septic shock are major complications of febrile neutropenia (FN) in pediatric patients with cancer (PPCs). The aim of the present study was to determine the association of vitamin D (VD) and cathelicidin levels with sepsis and septic shock in PPCs with FN. A prospective cohort of PPCs with FN who had previously received cytotoxic chemotherapy was analyzed. At baseline, the plasma levels of VD and cathelicidin were quantified. Patients with sepsis and septic shock were compared with patients with FN without complications. Relative risks (RRs) were calculated with 95% confidence intervals (95% CIs) to determine associations. Multiple logistic regression analysis was performed to adjust the results for the identified confounders. A total of 78 episodes of FN were included; 35 (44.8%) completed their FN treatment without complications, 19 (24.4%) presented with sepsis and 24 (30.8%) progressed to septic shock. The median plasma VD level was 15.2 ng/ml, while the median plasma cathelicidin level was 27.9 ng/ml. Patients with severe VD deficiency (RR, 2.34; 95% CI, 1.17-4.70) and patients with cathelicidin levels >41.5 ng/ml (RR, 2.44; 95% CI, 1.07-5.56) exhibited a higher risk of developing sepsis compared with the control group. Patients with severe VD deficiency had a higher risk of septic shock (RR, 1.96; 95% CI, 1.02-3.79) compared with patients without complications, while cathelicidin levels were not associated with septic shock. After adjusting for confounders, cathelicidin levels >41.5 ng/ml (odds ratio, 5.52; 95% CI, 1.17-26.06) remained as an independent risk factor for progressing to sepsis. In patients who developed septic shock, the multivariate model revealed <700 leukocytes/mm and glucose levels >100 mg/dl as independent risk factors. In conclusion, higher plasma cathelicidin levels were independently associated with progression to sepsis in PPCs with FN.
脓毒症和感染性休克是癌症患儿（PPCs）发热性中性粒细胞减少症（FN）的主要并发症。本研究的目的是确定维生素D（VD）和cathelicidin水平与PPCs合并FN时脓毒症和感染性休克的关联。对一组先前接受过细胞毒性化疗的PPCs合并FN患者进行了前瞻性队列分析。在基线时，对VD和cathelicidin的血浆水平进行了定量。将脓毒症和感染性休克患者与无并发症的FN患者进行比较。计算相对风险（RRs）及其95%置信区间（95% CIs）以确定关联。进行多因素逻辑回归分析以针对已识别的混杂因素调整结果。共纳入78例FN发作；35例（44.8%）无并发症地完成了FN治疗，19例（24.4%）出现脓毒症，24例（30.8%）进展为感染性休克。血浆VD水平中位数为15.2 ng/ml，而血浆cathelicidin水平中位数为27.9 ng/ml。与对照组相比，严重VD缺乏患者（RR，2.34；95% CI，1.17 - 4.70）和cathelicidin水平>41.5 ng/ml的患者（RR，2.44；95% CI，1.07 - 5.56）发生脓毒症的风险更高。与无并发症患者相比，严重VD缺乏患者发生感染性休克的风险更高（RR，1.96；95% CI，1.02 - 3.79），而cathelicidin水平与感染性休克无关。在对混杂因素进行调整后，cathelicidin水平>41.5 ng/ml（比值比，5.52；95% CI，1.17 - 26.06）仍然是进展为脓毒症的独立危险因素。在发生感染性休克的患者中，多变量模型显示白细胞计数<700/立方毫米和血糖水平>100 mg/dl为独立危险因素。总之，在PPCs合并FN患者中，较高的血浆cathelicidin水平与进展为脓毒症独立相关。
