Use of inflammatory markers for early detection of bacteraemia in patients with febrile neutropenia

Scand J Infect Dis. 2004;36(5):365-71. doi: 10.1080/00365540410020217.

Abstract

The aim of the study was to evaluate the ability of procalcitonin, C-reactive protein, serum amyloid A, interleukin-6 and interleukin-8 to predict bacteraemia during the 2 first d of fever in neutropenic patients. A total of 94 febrile neutropenic episodes in 60 patients were studied. Plasma samples were analysed at 10-h intervals from the onset of fever. Clinical events were categorized into 4 groups: 1) bacteraemia caused by other agents than coagulase-negative staphylococci (non-CNS bacteraemia) (n = 21), 2) coagulase-negative staphylococci bacteraemia (n = 15), 3) microbiologically or clinically documented infection without bacteraemia (n = 26) and 4) fever of unknown origin (n = 32). In non-CNS bacteraemia all markers, except for serum amyloid A, showed significantly higher levels compared to patients with fever of unknown origin (p < 0.05). For non-CNS bacteraemia the highest negative predictive value was found for procalcitonin (94%), followed by interleukin-6 (89%), C-reactive protein (88%) and interleukin-8 (87%). Procalcitonin, with a cut-off level of 1.4 ng/ml during 10-20 h after fever onset, showed the highest positive predictive value (67%) for a non-CNS bacteraemia. In conclusion, the value of the analysed markers to predict a non-CNS bacteraemia in neutropenic patients was limited due to low sensitivity and positive predictive value. However, procalcitonin, interleukin-6, C-reactive protein, and interleukin-8 could give useful information for the clinician in excluding a non-CNS bacteraemia.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Amyloid / analysis
  • Analysis of Variance
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use
  • Bacteremia / diagnosis*
  • Bacteremia / etiology
  • C-Reactive Protein / analysis
  • Calcitonin / analysis
  • Calcitonin Gene-Related Peptide
  • Cohort Studies
  • Female
  • Fever / diagnosis*
  • Fever / etiology
  • Hematologic Neoplasms / diagnosis
  • Hematologic Neoplasms / drug therapy
  • Humans
  • Inflammation Mediators / analysis*
  • Interleukin-6 / analysis
  • Interleukin-8 / analysis
  • Male
  • Middle Aged
  • Neutropenia / diagnosis*
  • Neutropenia / etiology
  • Probability
  • Prognosis
  • Protein Precursors / analysis
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Statistics, Nonparametric

Substances

  • Amyloid
  • Antineoplastic Agents
  • CALCA protein, human
  • Inflammation Mediators
  • Interleukin-6
  • Interleukin-8
  • Protein Precursors
  • Calcitonin
  • C-Reactive Protein
  • Calcitonin Gene-Related Peptide