Prediction of infectious complications by the combination of plasma procalcitonin level and localized infection before allogeneic hematopoietic cell transplantation

Sato, Miki; Nakasone, Hideki; Terasako‐Saito, Kiriko; Sakamoto, Kana; Yamazaki, Rie; Tanaka, Yukië; Akahoshi, Yu; Nakano, Hirofumi; Ugai, Tomotaka; Wada, Hiroo; Yamasaki, Ryo; Ishihara, Yuko; Kawamura, Koji; Ashizawa, Masahiro; Kimura, Shun‐ichi; Kikuchi, Misato; Tanihara, Aki; Kanda, Junya; Kako, Shinichi; Nishida, Junji

doi:10.1038/bmt.2013.217

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…22 Post-transplant infection included microbiologically documented infections and presumed infections based on clinical and/or radiological findings. 23 Febrile neutropenia was excluded if any other noninfectious etiology was highly suspected. Engraftment failure was defined as failure to achieve an ANC of 500/mm 3 by day 28 after transplantation.…”

Section: Study Subjectsmentioning

confidence: 99%

Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients

Shingai

Morito

Najima

et al. 2015

Bone Marrow Transplant

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Acute kidney injury (AKI) following stem-cell transplantation (SCT) contributes to a poor prognosis, yet its impact may vary depending on the timing of AKI onset. A prospective cohort study was performed to understand the significance of the onset timing in 103 allogeneic SCT (allo-SCT) recipients. AKI prior to stem-cell engraftment was defined as early AKI and subsequently occurring AKI as late AKI. Propensity score (PS) for early AKI was calculated using a logistic regression model to reduce confounding effects related to differences in clinical background between the early and late AKI groups. The cumulative incidences of early and late AKI were 22.3% and 54.9%, respectively. Non-relapse mortality (NRM) was 39.1% and 7.0%, and overall survival (OS) was 56.5% and 90.9% in early and late AKI at 100 days after AKI, respectively (Po 0.001). The cumulative incidence of chronic kidney disease (CKD) over 2 years after SCT was 41.5% and 19.1% in early and late AKI, respectively (P = 0.048). Logistic regression analysis adjusted for the PS showed that early AKI was significantly associated with OS (odds ratio (95% confidence interval); 4.63 (1.15-21.4), P = 0.031) but with neither NRM (1.25 (0.28-5.33), P = 0.766) nor CKD (1.85 (0.41-8.60), P = 0.422). In conclusion, early AKI may portend a poor survival for allo-SCT recipients.

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Section: Study Subjectsmentioning

confidence: 99%

Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients

Shingai

Morito

Najima

et al. 2015

Bone Marrow Transplant

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“…Sato et al reported that a relatively high serum CRP level before the first consolidation chemotherapy was predictive of infectious events after the initial chemotherapy had reduced the interference effect of tumor cells on CRP levels, the area under the ROC curve (AUC) was 0.67 [22]. In patients with allogeneic hematopoietic cell transplantation, two studies reported a significantly greater number of infections in the high-CRP quartile compared to the low-CRP group [20,21], but other studies found that baseline CRP levels were not independently significantly predictive of infectious events [23,24], possibly due to an insufficient sample size or the effect of prophylactic antibiotics. The results of this study in a large population reinforce the connection, the CRP levels pre-LT were independently associated with 30-day CSI post-transplant.…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein Is an Independent Predictor of 30-Day Bacterial Infection Post-Liver Transplantation

Shi

et al. 2021

Biomolecules

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The relationship between aseptic systemic inflammation and postoperative bacterial infection is unclear. We investigated the correlation of systemic inflammation biomarkers with 30-day clinically significant bacterial infections (CSI) after liver transplantation (LT). This retrospective study enrolled 940 patients who received LT and were followed for 30 days. The primary end point was 30-day CSI events. The cohort was divided into exploratory (n = 508) and validation (n = 432) sets according to different centers. Area under the receiver operated characteristic (AUROC) and Cox regression models were fitted to study the association between baseline systemic inflammation levels and CSI after LT. A total of 255 bacterial infectious events in 209 recipients occurred. Among systemic inflammation parameters, baseline C-reactive protein (CRP) was independently associated with 30-day CSI in the exploratory group. The combination of CRP and organ failure number showed a good discrimination for 30-day CSI (AUROC = 0.80, 95% CI, 0.76–0.84) and the results were confirmed in an external verification group. Additionally, CRP levels were correlated with bacterial product lipopolysaccharide. In conclusion, our study suggests that pre-transplantation CRP is independent of other prognostic factors for 30-day CSI post-LT, and can be integrated into tools for assessing the risk of bacterial infection post-LT or as a component of prognostic models.

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“…Fever was defined as an axillary body temperature of 37.5 ° C or more according to the diagnostic criteria for febrile neutropenia. Except for bloodstream infections (BSIs), documented infections DIs were defined as microbiologically documented or presumed infections based on clinical and/or radiological findings 7 . BSIs were analyzed independently from general “ documented infection ” in this study.…”

Section: Methodsmentioning

confidence: 99%

Procalcitonin elevation in febrile recipients during pre-transplant conditioning with anti-thymocyte globulin

2024

BCT

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Infection is a major contributor to non-relapse mortality in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Detecting infectious diseases in febrile patients during pretransplant conditioning is crucial for subsequent transplant success. Procalcitonin (PCT) is an auxiliary diagnostic marker of severe bacterial infections and has been proposed as a useful predictor of infection in patients undergoing allo-HSCT. Pre-transplant use of anti-thymocyte globulin (ATG) can cause side effects, such as fever and hypotension, which must be distinguished from infectious diseases. Although ATG administration may increase PCT levels, data on PCT levels in febrile patients after ATG administration are limited. Furthermore, no studies have compared PCT levels during allo-HSCT conditioning using ATG or non-ATG regimens. To investigate whether ATG increases PCT levels during febrile episodes in pre-transplant conditioning and whether PCT could be used to discriminate infections during this period, we analyzed 17 ATG and 59 non-ATG patients with fever and who underwent PCT level measurements during pre-transplant conditioning. Our findings revealed that ATG administration was the only significant factor that increased PCT positivity during fever ( p = 0.01). In contrast, infectious diseases did not affect PCT positivity in the ATG group ( p = 0.24). Furthermore, bloodstream infection was a significant risk factor for PCT positivity in patients who received non-ATG regimens ( p < 0.01). Incorporating PCT levels into the diagnostic workup for infectious diseases requires careful consideration, particularly for patients receiving ATG regimens.

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Prediction of infectious complications by the combination of plasma procalcitonin level and localized infection before allogeneic hematopoietic cell transplantation

Cited by 8 publications

References 18 publications

Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients

Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients

C-Reactive Protein Is an Independent Predictor of 30-Day Bacterial Infection Post-Liver Transplantation

Procalcitonin elevation in febrile recipients during pre-transplant conditioning with anti-thymocyte globulin

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