Diagnostic value of sepsis biomarkers in hematopoietic stem cell transplant recipients in a condition of high prevalence of gram-negative pathogens

Stoma, Igor; Karpov, Igor; Uss, Anatoly; Руммо, О. О.; Миланович, Н. Ф.; Искров, И. А.

doi:10.1016/j.hemonc.2016.09.002

Cited by 21 publications

(11 citation statements)

References 32 publications

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“…However, the diagnostic value did increase on the second day of fever (56% sensitivity, 90% specificity) which is similar to our findings (16). Stoma et al (17) suggested that PCT is a good diagnostic marker with a 62% sensitivity and an 88% specificity in adult patients with Gram-negative BSI following hematopoietic stem cell transplant. In our study, at fever onset, PCT levels showed a lower specificity (51.1%) in predicting BSI caused by Gram-negative microorganisms.…”

Section: Discussionsupporting

confidence: 91%

Can Serial Measurement Enhance the Diagnostic Value of Procalcitonin as a Marker of Gram-negative Bacteremia in Children with Acute Leukemia?

Bal¹,

Ercan²,

Karapınar³

2019

jpr

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Despite improvements in diagnosis and treatment, infections are still major cause of morbidity and mortality in children with febrile neutropenia (FN). In these patients, due to inadequate inflammatory response and subtle clinical symptoms, to determine the source of infection can be challenging. Therefore, it is important to distinguish infections from other non-infectious causes, for both to choose appropriate antibiotic and to reduce the redundant antibiotic use. Materials and Methods: In this retrospective study, we aim to evaluate serial procalcitonin (PCT) levels for predicting bacteremia particularly caused by Gram-negative microorganism. Results: Among FN episodes caused by Gram-negative microorganism, the median level of second PCT sample obtained between 48 and 72 hours PCT 2 was found to be significantly higher when compared to infections caused by Coagulase-negative Staphylococcus or culturenegative confirmed infections, p value was 0.003; however, fever onset PCT 1 and C-reactive protein (CRP) 1 values showed no significant difference (p>0.05). The area under curve values demonstrated by receiver operating characteristic (ROC) analysis for CRP 1, CRP 2, PCT 1, PCT 2 were 0.664, 0.748, 0.504 and 0.842, respectively. Conclusion: This study showed that initial PCT levels were not significantly correlate with culture-confirmed bacterial infection. Therefore, initial PCT values do not help the clinicians in terms of administering or postponing empirical antibiotics at the time of fever onset. However, third day PCT levels present as a good diagnostic marker due to a higher sensitivity and specificity when comparing them to the initial values. Determination of serial PCT may enhance the diagnostic value of PCT diagnostic marker in FN episodes caused by Gram-negative bacteria with a high sensitivity (87.5%). This study also demonstrated that PCT could be used to rule out bacterial infections particularly caused by Gram-negative bacteria.

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Section: Discussionsupporting

confidence: 91%

Can Serial Measurement Enhance the Diagnostic Value of Procalcitonin as a Marker of Gram-negative Bacteremia in Children with Acute Leukemia?

Bal¹,

Ercan²,

Karapınar³

2019

jpr

View full text Add to dashboard Cite

show abstract

“…However, the diagnostic value did increase on the second day of fever (56% sensitivity, 90% specificity) which is similar to our findings (16). Stoma et al (17) suggested that PCT is a good diagnostic marker with a 62% sensitivity and an 88% specificity in adult patients with Gram-negative BSI following hematopoietic stem cell transplant (HSCT). In this study, at fever onset, PCT levels showed a lower specificity (51.1%) in predicting BSI caused by Gram-negative microorganisms.…”

Section: Discussionsupporting

confidence: 90%

Can Serial Measurement Enhance the Diagnostic Value of Procalcitonin as a Marker of Gram-Negative Bacteremia in Children with Acute Leukemia?

Bal¹,

Ercan²,

Karapınar³

2018

jpr

View full text Add to dashboard Cite

Despite improvements in diagnosis and treatment, infections are still major cause of morbidity and mortality in children with febrile neutropenia (FN). In these patients, due to inadequate inflammatory response and subtle clinical symptoms, to determine the source of infection can be challenging.Therefore, it is important to distinguish infections from other non-infectious causes, for both to choose appropriate antibiotic and to reduce the redundant antibiotic use. Materials and Methods: In this retrospective study, we aim to evaluate serial procalcitonin (PCT) levels for predicting bacteremia particularly caused by Gram-negative microorganism. Results: Among FN episodes caused by Gram-negative microorganism, the median level of second PCT sample obtained between 48 and 72 hours (PCT 2) was found to be significantly higher when compared to infections caused by Coagulase-negative Staphylococcus (CoNS) or culture-negative confirmed infections, P value was 0.003; however, fever onset PCT 1 and C-reactive protein (CRP) 1 values showed no significant difference (P>0.05). The area under curve (AUC) values demonstrated by ROC analysis for CRP 1, CRP 2, PCT 1, PCT 2 were 0.664, 0.748, 0.504 and 0.842, respectively. Conclusion: This study showed that initial PCT levels were not significantly correlate with culture-confirmed bacterial infection. Therefore, initial PCT values do not help the clinicians in terms of administering or postponing empirical antibiotics at the time of fever onset. However, third day PCT levels present as a good diagnostic marker due to a higher sensitivity and specificity when comparing them to the initial values. Determination of serial PCT may enhance the diagnostic value of PCT diagnostic marker in FN episodes caused by Gram-negative bacteria with a high sensitivity (87.5%). This study also demonstrated that PCT could be used to rule out bacterial infections particularly caused by Gram-negative bacteria.

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“…The relationship between plasma presepsin levels and pathogens is not clear. Stoma et al showed that plasma presepsin level was frequently elevated in patients with gram-negative bacteremia (27). Concerning pneumonia, Qi et al showed that patients with gram-negative bacterial pneumonia had significantly higher value of plasma presepsin level than those with gram-positive bacterial pneumonia (28).…”

Section: Discussionmentioning

confidence: 99%

Impact of initial plasma presepsin level for clinical outcome in hospitalized patients with pneumonia

Ugajin

Matsuura

et al. 2019

J. Thorac. Dis

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Background: Presepsin, the soluble CD14 subtype, is known as a sepsis biomarker. However, its clinical significance in pneumonia is unclear. We investigated the effects of plasma presepsin level on clinical outcomes in patients with pneumonia. Methods: Patients over 18 years old admitted to our hospital due to pneumonia from May 2016 through November 2017 were reviewed using electronic medical records. One hundred and seventy-two patients who underwent measurement of plasma presepsin levels on admission were enrolled. Median age of enrolled patients was 81 years [interquartile range (IQR), 68-86 years]. Pneumonia severity index (PSI) class and A-DROP score on admission were calculated. The receiver operating characteristic (ROC) curve analysis was performed to assess the prognostic value of 30-day mortality and to identify the optimal cutoff value of plasma presepsin level. Correlations between plasma presepsin level and other factors were assessed using the Spearman's test. The Kaplan-Meier survival analysis and the log-rank test were performed to assess the two curves differentiated with the optimal cutoff value of plasma presepsin level. Results: Seventeen patients (9.9%) died within 30 days of admission. The deceased patients had higher value of plasma presepsin on admission (539 pg/mL; IQR, 414-832 pg/mL) compared with the survivors (334 pg/mL; IQR, 223-484 pg/mL) (P=0.001). The areas under ROC curve for predicting 30-day mortality were 0.742 for plasma presepsin, 0.755 for A-DROP score, and 0.774 for PSI class. Plasma presepsin level was not associated with etiology of pneumonia. However, it was moderately correlated with serum creatinine level (rs =0.524, P<0.001). The ROC curve analysis derived 470 pg/mL of plasma presepsin level as the optimal cutoff value for predicting 30-day mortality. The Kaplan-Meier survival analysis showed that patients with plasma presepsin level ≥470 pg/mL on admission had significantly higher 30-day mortality than those with plasma presepsin level <470 pg/mL (P<0.001). Among patients with A-DROP score ≥3, those with plasma presepsin level ≥470 mg on admission had significantly higher 30-day mortality (P=0.013). Similarly, among patients with PSI class ≥4, those with plasma presepsin level ≥470 mg on admission had significantly higher 30-day mortality (P=0.005). Conclusions: In hospitalized pneumonia patients, plasma presepsin level on admission could be a useful predictor of 30-day mortality and an additional prognostic biomarker on existing severity assessment scales.

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Diagnostic value of sepsis biomarkers in hematopoietic stem cell transplant recipients in a condition of high prevalence of gram-negative pathogens

Cited by 21 publications

References 32 publications

Can Serial Measurement Enhance the Diagnostic Value of Procalcitonin as a Marker of Gram-negative Bacteremia in Children with Acute Leukemia?

Can Serial Measurement Enhance the Diagnostic Value of Procalcitonin as a Marker of Gram-negative Bacteremia in Children with Acute Leukemia?

Can Serial Measurement Enhance the Diagnostic Value of Procalcitonin as a Marker of Gram-Negative Bacteremia in Children with Acute Leukemia?

Impact of initial plasma presepsin level for clinical outcome in hospitalized patients with pneumonia

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