Febrile neutropenia remains a frequent complication in onco-hematological
patients, and changes in the circulating level of inflammatory molecules (IM)
may precede the occurrence of fever. The present observational prospective study
was carried out to evaluate the behavior of plasma tumor necrosis factor alpha
(TNF-α), soluble TNF-α I and II receptors (sTNFRI and sTNFRII), monocyte
chemoattractant protein-1 [MCP-1 or chemokine (c-c motif) ligand 2 (CCL2)],
macrophage inflammatory protein-1α (MIP-1α or CCL3), eotaxin (CCL11),
interleukin-8 (IL-8 or CXCL8), and interferon-inducible protein-10 (IP-10 or
CXCL10) in 32 episodes of neutropenia in 26 onco-hematological patients. IM were
tested on enrollment and 24-48 h before the onset of fever and within 24 h of
the first occurrence of fever. Eight of 32 episodes of neutropenia did not
present fever (control group) and the patients underwent IM tests on three
different occasions. sTNFRI levels, measured a median of 11 h (1-15) before the
onset of fever, were significantly higher in patients presenting fever during
follow-up compared to controls (P = 0.02). Similar results were observed for
sTNFRI and CCL2 levels (P = 0.04 for both) in non-transplanted patients. A
cut-off of 1514 pg/mL for sTNFRI was able to discriminate between neutropenic
patients with or without fever during follow-up, with 65% sensitivity, 87%
specificity, and 93% positive predictive value. Measurement of the levels of
plasma sTNFRI can be used to predict the occurrence of fever in neutropenic
patients.
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