Diagnostic value of sTREM-1, IL-8, PCT, and CRP in febrile neutropenia after autologous stem cell transplantation

Abstract

Infections and infectious complications are the major cause of morbidity and mortality in febrile neutropenic patients after autologous stem cell transplantation. Laboratory biomarkers are helpful for early identification of critically ill patients and optimal therapy management. Several studies in adult non-neutropenic patients proposed sTREM-1 as a superior biomarker for identification of septic patients as well as a predictor for survival in these patients compared with procalcitonin (PCT), C-reactive protein (CRP), or interleukin-8 (IL-8). Here, to assess the utility of PCT, CRP, IL-8, and sTREM-1 in febrile neutropenia, 44 patients presenting with febrile neutropenia after autologous stem cell transplantation were recruited in a single-center prospective pilot study. We analyzed PCT and CRP as well as IL-8 and sTREM-1 levels pre- and post-transplantation at defined time points. In 20 of 44 patients, concentration of sTREM-1 was under the detection level at appearance of febrile neutropenia. Mean levels of PCT, IL-8, and CRP were significantly increased in infections of critically ill patients who by dysfunction or failure of one or more organs/system depend on survival from advanced instruments of monitoring and therapy. However, all tested biomarkers could not distinguish between presence and absence of bloodstream infection. The combination of the biomarkers PCT and IL-8 achieved a high sensitivity of 90% and specificity of 74% for the identification of serious complications in febrile neutropenia, whereas the combination of CRP and PCT or IL-8 achieved a high sensitivity of 100%, but with the addition of a low specificity of 47or 41%. In conclusion, we found that the measurement of sTREM-1 concentration at presentation of febrile neutropenia is not useful to identify bacterial bloodstream infections and critically ill patients. PCT and IL-8 are useful biomarkers for the early identification of critically ill patients, compared to CRP and sTREM-1 in febrile neutropenia. PCT or IL-8 in combination with clinical parameters should be considered in routine measurement to identify critically ill patients as early as possible.

Comparison of Presepsin, Procalcitonin, Interleukin-8 and C-Reactive Protein in Predicting Bacteraemia in Febrile Neutropenic Adult Patients With Haematological Malignancies

“…At a cut-off value of 170 pg/ml, IL-8 correlated with all cases of gram-positive bacteraemia and 6/7 of gram-negative bacteraemia. Our result is consistent with recent evidence correlating IL-8 with bacteraemia in paediatric haematological patients, especially in Gram-negative bacteraemia 18–21…”

Prognostic value of procalcitonin and lipopolysaccharide binding protein in cancer patients with chemotherapy-associated febrile neutropenia presenting to an emergency department

“…In studies using the same adverse events as Klastersky et al to define serious complications, the results reported about the role of PCT are controversial ( 2 ). Recently, in a haematological population, Michel et al reported a ROC AUC for PCT of 0.92, higher than other biological markers, such as IL-8 (ROC AUC: 0.81) and C-reactive protein (ROC AUC: 0.72), with an optimal cut-off 0.5 mg/L, similar to that chosen in our study (0.43 mg/L), and with a sensitivity and specificity of 80% and 76%, respectively ( 15 ). Interestingly, in Ahn et al study, similarly to our results, PCT was an independent predictor for complications, with an OR of 5.76 (7).…”

“…Previous studies have analysed the prognostic role of biomarkers in febrile neutropenia patients ( 13 - 15 ). However, the comparison of results reported in these studies is limited due to differences in the definition of outcomes, having been included in some studies events such as bacteraemia, severe sepsis and septic shock or treatment failure as adverse events.…”

“…The role of biomarkers to predict bacteraemia and other bloodstream infections has been widely studied in different settings, including patients presenting at ED and adult and child cancer patients with and without neutropenia ( 6 , 15 , 18 - 23 ). In a recent meta-analysis, Hoeboer et al reported a ROC AUC of 0.78 to predict bacteraemia in patients with suspected infection presenting at an emergency department, decreasing to 0.71 in immunocompromised/neutropenic patients ( 24 ).…”

Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies

“…However, CRP levels are frequently increased in non-infectious complications. They show low specificity for infection, especially in patients with hematologic malignancies [5–8]. PCT is useful for the diagnosis of sepsis.…”