C-reactive protein in critically ill cancer patients with sepsis: influence of neutropenia

Abstract

IntroductionSeveral biomarkers have been studied in febrile neutropenia. Our aim was to assess C-reactive protein (CRP) concentration in septic critically ill cancer patients and to compare those with and without neutropenia.MethodsA secondary analysis of a matched case-control study conducted at an oncologic medical-surgical intensive care unit (ICU) was performed, segregating patients with severe sepsis/septic shock. The impact of neutropenia on CRP concentrations at admission and during the first week of ICU stay was assessed.ResultsA total of 154 critically ill septic cancer patients, 86 with neutropenia and 68 without, were included in the present study. At ICU admission, the CRP concentration of neutropenic patients was significantly higher than in non-neutropenic patients, 25.9 ± 11.2 mg/dL vs. 19.7 ± 11.4 mg/dL (P = 0.009). Among neutropenic patients, CRP concentrations at ICU admission were not influenced by the severity of neutropenia (< 100/mm3 vs. ≥ 100/mm3 neutrophils), 25.1 ± 11.6 mg/dL vs. 26.9 ± 10.9 mg/dL (P = 0.527). Time dependent analysis of CRP from Day 1 to Day 7 of antibiotic therapy showed an almost parallel decrease in both groups (P = 0.335), though CRP of neutropenic patients was, on average, always higher in comparison to that of non-neutropenic patients.ConclusionsIn septic critically ill cancer patients CRP concentrations are more elevated in those with neutropenia. However, the CRP course seems to be independent from the presence or absence of neutropenia.

sTREM-1 predicts intensive care unit and 28-day mortality in cancer patients with severe sepsis and septic shock

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The Innate Immune Response in HIV/AIDS Septic Shock Patients: A Comparative Study

“…Our data suggest that systemic inflammatory response can be induced in HIV patients with septic shock, which is similar in non-HIV patients. Póvoa and colleagues (2011) observed that the CRP levels were increased in severely immunosuppressed cancer patients with sepsis, and CRP course was alike from the presence or absence of neutropenia [34]. If we take these evidences together, it seems that immunosuppression has no major effect on the acute phase response to severe infections.…”

Pros and cons of using biomarkers versus clinical decisions in start and stop decisions for antibiotics in the critical care setting

“…Other authors proposed different PCT cutoff values for patients with chronic kidney disease but these have not been prospectively tested [24]. Both CRP and PCT kinetics are independent of neutropenia [26,27].…”