Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia
Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia
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DOI：
10.3109/00365548.2011.554855
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发表时间：
2011-07-01
影响因子：
--
通讯作者：
Juutilainen, Auni
中科院分区：
文献类型：
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作者：
Koivula, Irma;Hamalainen, Sari;Juutilainen, Auni
目的：比较半定量降钙素原与 C 反应蛋白预测中性粒细胞减少性发热血液病患者菌血症的效果。方法：共有 77 名在库奥皮奥大学医院接受强化化疗的血液恶性肿瘤患者作为研究候选者。其中11名患者不符合中性粒细胞减少性发热标准，最终纳入66名患者。 19 名患者患有急性髓系白血病，47 名患者接受了自体干细胞移植支持的大剂量化疗。这 66 名患者中的 90 次中性粒细胞减少性发热发作符合研究进入标准，可进行微生物培养、降钙素原和 C 反应蛋白测量。在第 0 天每次中性粒细胞减少性发热发作时分析血清降钙素原和 C 反应蛋白，然后从第 1 天到第 4 天每天进行分析。结果：在 21 次发作中观察到菌血症（23%），在 13 次发作中（14%）满足严重败血症的标准。一半菌血症是由革兰氏阴性菌引起的。降钙素原和 C 反应蛋白的动力学相似，在发烧后 2 至 4 天内水平不断升高。第 1、2、3 和 4 天的降钙素原水平与菌血症和革兰氏阴性菌血症相关，但与严重败血症的发展无关。第 1 天，降钙素原水平高于 0.5 ng/ml 时，预测菌血症和革兰氏阴性菌血症的敏感性分别为 57% 和 70%，特异性为 81% 和 77%。结论：中性粒细胞减少性发热发作后 24 小时内降钙素原水平升高可预测血液病患者发生菌血症和革兰氏阴性菌血症。
Objective: To compare semi-quantitative procalcitonin with C-reactive protein in predicting bacteraemia in haematological patients with neutropenic fever. Methods: A total of 77 patients treated with intensive chemotherapy for haematological malignancy at Kuopio University Hospital were candidates for study entry. Eleven of these patients did not fulfil the criteria for neutropenic fever, and 66 patients were finally included. Nineteen patients had acute myeloid leukaemia and 47 had received high-dose chemotherapy supported by autologous stem cell transplant. Ninety neutropenic fever episodes in these 66 patients fulfilled the study entry criteria, with microbiological cultures, procalcitonin and C-reactive protein measurements available. Serum procalcitonin and C-reactive protein were analyzed at the onset of each neutropenic fever episode on day 0, and then daily from days 1 to 4. Results: Bacteraemia was observed in 21 episodes (23%) and the criteria for severe sepsis were fulfilled in 13 episodes (14%). Half of the bacteraemic episodes were caused by Gram-negative bacteria. The kinetics of procalcitonin and C-reactive protein were similar, with increasing levels for 2 to 4 days after the onset of fever. The procalcitonin level on days 1, 2, 3 and 4 was associated with bacteraemia and Gram-negative bacteraemia, but not with the development of severe sepsis. On day 1, a procalcitonin level above 0.5 ng/ml had a sensitivity of 57% and 70% and specificity of 81% and 77% to predict bacteraemia and Gram-negative bacteraemia, respectively. Conclusions: An elevated level of procalcitonin within 24 h after the onset of neutropenic fever predicts bacteraemia and Gram-negative bacteraemia in haematological patients.