Markers of bacteremia in febrile neutropenic patients with hematological malignancies: procalcitonin and IL-6 are more reliable than C-reactive protein
Markers of bacteremia in febrile neutropenic patients with hematological malignancies: procalcitonin and IL-6 are more reliable than C-reactive protein
复制标题
DOI：
10.1007/s10096-004-1156-y
复制
发表时间：
2004-07-01
影响因子：
4.5
通讯作者：
Stuber, F
中科院分区：
文献类型：
--
作者：
von Lilienfeld-Toal, M;Dietrich, MP;Stuber, F
由于嗜中性粒细胞减少的血液系统恶性肿瘤患者感染危及生命的感染的风险很高，在发热性嗜中性粒细胞减少的病例中需要特定的感染标志物。本研究评估了31例发热性中性粒细胞减少症患者血清中c反应蛋白（CRP）、降钙素原（PCT）和白细胞介素-6 （IL-6）的浓度。总共评估了53次发作，其中18次与阳性血培养结果相关。降钙素原和IL-6浓度在菌血症和非菌血症发作间差异显著。无菌血症肺炎患者降钙素原值为0.22 ng/ml[四分位数范围（IR）， 0.15-1.9]，不明原因发热患者降钙素原值为0.22 ng/ml (IR, 0.16-0.55)，非微生物性发热患者降钙素原值为0.2 ng/ml (IR, 0.13-0.57)，菌血症患者降钙素原值为1.8 ng/ml （IR, 0.35-5.3）。使用Mann-Whitney检验，菌血症和非菌血症发作之间的差异的p值为0.003。对于IL-6，无菌血症肺炎患者的中位数为301 pg/ml (IR, 152- 1879)，不明原因发热患者的中位数为207 pg/ml (IR, 94-445)，非微生物性发热患者的中位数为177 pg/ml (IR, 142-208)，菌血症患者的中位数为942 pg/ml （IR, 181- 2807）。使用Mann-Whitney检验，菌血症和非菌血症发作的差异P=0.006。CRP浓度无差异。根据受试者工作特征曲线选择区分菌血症和非菌血症发作的截止水平：PCT为0.62 ng/ml， IL-6为297 pg/ml。PCT阴性预测值为84%，IL-6阴性预测值为70%。结果提示PCT和IL-6在预测发热性中性粒细胞减少患者菌血症方面比CRP更可靠。
Since neutropenic patients with hematological malignancies are at high risk of contracting life-threatening infections, specific markers of infection are needed in cases of febrile neutropenia. The study presented here assessed serum concentrations of C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) in samples obtained from 31 febrile neutropenic patients. A total of 53 episodes were evaluated, and 18 of these were associated with positive blood culture results. Procalcitonin and IL-6 concentrations differed significantly between bacteremic and non-bacteremic episodes. Procalcitonin values were 0.22 ng/ml [interquartile range (IR), 0.15-1.9] for patients with pneumonia without bacteremia, 0.22 ng/ml (IR, 0.16-0.55) for patients with fever of unknown origin, 0.2 ng/ml (IR, 0.13-0.57) for patients with non-microbial fever and 1.8 ng/ml (IR, 0.35-5.3) for patients with bacteremia. The differences between bacteremic and non-bacteremic episodes had a P-value of 0.003 using the Mann-Whitney test. For IL-6 the median values were 301 pg/ml (IR, 152-1,879) for patients with pneumonia without bacteremia, 207 pg/ml (IR, 94-445) for patients with fever of unknown origin, 177 pg/ml (IR, 142-208) for patients with non-microbial fever and 942 pg/ml (IR, 181-2,807) for patients with bacteremia. Using the Mann-Whitney test, the differences between bacteremic and non-bacteremic episodes were P=0.006. No differences were found in CRP concentrations. Cutoff levels to distinguish between bacteremic and non-bacteremic episodes were chosen using receiver operating characteristic curves: 0.62 ng/ml for PCT and 297 pg/ml for IL-6. Negative predictive values were 84% for PCT and 70% for IL-6. The results indicate that PCT and IL-6 are more reliable markers than CRP for predicting bacteremia in patients with febrile neutropenia.