The predictive value of soluble biomarkers (CD14 subtype, interleukin-2 receptor, human leucocyte antigen-G) and procalcitonin in the detection of bacteremia and sepsis in pediatric oncology patients with chemotherapy-induced febrile neutropenia

Urbonas, Vincas; Eidukaitė, Audronė; Tamulienė, Indrė

doi:10.1016/j.cyto.2013.02.030

Cited by 48 publications

(41 citation statements)

References 15 publications

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“…Some authors found that CRP, PCT and presepsin serum values were significantly higher in the bacteremic population without any differences among the blood culture-positive, -negative and mixed flora groups [7]. In a pediatric oncology population with febrile neutropenia, PCT levels were significantly higher in the sepsis/bacteriemia group (where infections were further confirmed with positive blood cultures) compared to the fever of unknown origin (FUO) group (with negative blood cultures) whereas presepsin concentrations did not differ between the two groups [25].…”

Section: Diagnostic Role and Diagnostic Accuracymentioning

confidence: 86%

Role of presepsin for the evaluation of sepsis in the emergency department

Pizzolato

Ulla

Galluzzo

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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Sepsis, severe sepsis and septic shock are among the most common conditions handled in the emergency department (ED). According to new Sepsis Guidelines, early diagnosis and treatment are the keys to improve survival. Plasma C-reactive protein (CRP) and procalcitonin (PCT) levels, when associated with documented or suspected infection, are now part of the definitions of sepsis. Blood culture is the gold standard method for detecting microorganisms but it requires too much time for results to be known. Sensitive biomarkers are required for early diagnosis and as indexes of prognosis sepsis. CRP is one of the acute phase proteins synthesized by the liver: it has a great sensitivity but a very poor specificity for bacterial infections. Moreover, the evolution of sepsis does not correlate with CRP plasma changes. In recent years PCT has been widely used for sepsis differential diagnosis, because of its close correlation with infections, but it still retains some limitations and false positivity (such as in multiple trauma and burns). Soluble CD14 subtype (sCD14-ST), also known as presepsin, is a novel and promising biomarker that has been shown to increase significantly in patients with sepsis, in comparison to the healthy population. Studies pointed out the capability of this biomarker for diagnosing sepsis, assessing the severity of the disease and providing a prognostic evaluation of patient outcome. In this mini review we mainly focused on presepsin: we evaluate its diagnostic and prognostic roles in patients presenting to the ED with systemic inflammatory response syndrome (SIRS), suspected sepsis or septic shock.

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Section: Diagnostic Role and Diagnostic Accuracymentioning

confidence: 86%

Role of presepsin for the evaluation of sepsis in the emergency department

Pizzolato

Ulla

Galluzzo

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Presepsin is seen as a good biomarker of neonatal sepsis, specifically for very early diagnosis, and can be used as a predictor of complications and death (26). In pediatric oncology patients with chemotherapy-induced febrile neutropenia and sepsis, PCT and soluble IL-2 receptor (sIL-2R) levels were considerably higher in a group with bacteremia or sepsis than in a group with fever of unknown origin, whereas levels of sCD14-ST between investigated groups did not differ significantly (27). The neutropenia might be the cause of the different conclusions from those of the other studies.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Presepsin (sCD14-ST) for Prediction of Bacterial Infection in Cerebrospinal Fluid Samples from Children with Suspected Bacterial Meningitis or Ventriculitis

et al. 2015

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P lacement of external ventricular drainage (EVD) and draining of the cerebrospinal fluid (CSF) when intracranial pressure (ICP) is elevated are frequently used for treating intracranial hypertension caused by a variety of neurological conditions. However, such an invasive procedure allows free entrance for bacteria and presents an increased risk of infection that can lead to meningitis, ventriculitis, or even death. The incidence of EVD-related ventriculitis ranges from 10% to 27% according to the literature (1-5). The most significant group of microorganisms causing ventriculitis is Staphylococcus spp., especially coagulase-negative staphylococci, followed by Staphylococcus aureus. Other Grampositive organisms, such as Streptococcus spp., Enterococcus spp., Corynebacterium spp., and Propionibacterium spp., may be involved. Most ventricular infections are a result of contamination during the insertion of the EVD (6, 7). In order to prevent this complication or to detect initiating steps of the disease, early diagnosis and treatment are crucial, yet little has been reported in the literature about its management. The CSF total cell count, differential count, and concentration of proteins and glucose are parameters providing early information pertaining to the diagnosis of bacterial CSF infection. However, cell counts are often unreliable because of blood contamination of the CSF caused by primary or secondary ventricular hemorrhage or by chemical reactions to the drain material. Blood laboratory markers are also frequently elevated because of concomitant bacterial infection (8). C-reactive protein (CRP) and procalcitonin (PCT) were tested for their use to predict infection, but the results were contradictory (8, 9). Bacteriological culture methods such as CSF cultures may take several days until bacterial growth can safely be excluded (9). Furthermore, many patients with EVD are on antibiotic therapy and isolation of bacteria from CSF is often difficult. Thus, there is a need for new markers with higher specificity for early detection of meningitis and ventriculitis. Brain macrophages play a pivotal role during inflammatory reactions of the central nervous system (CNS) parenchyma, ventricles, and meninges, and are involved in the release of soluble CD14 (sCD14) (10). In a study of 91 patients, serum sCD14 levels were measured, and the levels increased during acute bacterial meningitis. Increased CSF and serum sCD14 concentrations were also observed in meningitis caused by viral infection. Repeated measurement of sCD14 in CSF revealed a normalization of sCD14 levels during clinical recovery (10). Determination of presepsin (sCD14-ST) in CSF could overcome problems with time-consuming procedures while measuring sCD14. CD14 is a glycosylphosphatidylinositol (GPI)-anchored glycoprotein

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“…Olad et al demonstrated that in the absence of other clinically detectable sources of inflammation, presepsin level was significantly higher in blood culture positives, but there was no significant difference between positive and negative blood culture group or between febrile or afebrile group [17]. Urbonas et al proved that there is no significant difference in presepsin levels between patients with bacteraemia/sepsis and fever of unknown origin [20].…”

Section: Discussionmentioning

confidence: 99%

“…There are only few existing paediatric studies focused on analysis of presepsin's diagnostic usefulness, mainly in newborns [18,21]. Papers considered febrile episodes in childhood oncology patients reported also inconclusive results [17,20]. Olad et al demonstrated that in the absence of other clinically detectable sources of inflammation, presepsin level was significantly higher in blood culture positives, but there was no significant difference between positive and negative blood culture group or between febrile or afebrile group [17].…”

Section: Discussionmentioning

confidence: 99%

The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients

Plesko¹,

Suvada²,

Makohusová³

et al. 2016

neo

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Bacterial infection is the most common complication in paediatric oncological patients during cancer treatment. A suitable tool for early prediction of unfavourable course of infection is still needed. We performed a prospective longitudinal observational study to evaluate of the role of serum biomarkers (C-reactive protein, procalcitonin, interleukin-6, presepsin) in the early diagnosis of bacteraemia (gram-negative versus gram-positive) in patients with haematological malignancies. We observed 69 febrile episodes in 33 patients (17 male, 16 female; 1.5-18.9 years, mean 7.31 years, median 5 years). Within this sample, there were 22 cases of positive blood cultures, 16 cases of sepsis, 38 cases of fever with no signs or symptoms of sepsis, and two deaths from infectious complications. All markers tested had good negative predictive value (73% -93%). CRP was characterized by good specificity for registration bacteraemia (96%, 95% CI: 85% -99%), but other results were inconclusive. We identified comparably balanced sensitivity (64% -81%) and specificity (61% -88%) for interleukin-6 and procalcitonin, and we proved their quality to predict positive blood culture and clinical signs of sepsis as well. Patients with gram-negative bacteraemia had significantly elevated levels of PCT and IL-6 in comparison with a group of patients with gram-positive bacteraemia (p = 0.04 for PCT and p = 0.005 for IL-6). Presepsin was characterized by poor specificity (27%, 95% CI: 15% -43%) and positive predictive value (24%, 95% CI: 12 -39%) for predicting bacteraemia, and by better sensitivity (84%, 95% CI: 55% -98%) and specificity (58%, 95% CI: 42% -73%) for predicting clinical signs of sepsis. Key words: C-reactive protein, procalcitonin, interleukin-6, presepsin, fever, sepsisBacterial infection is the most common treatment-related complication in patients with haematological malignancies [1]. Documented mortality associated with paediatric febrile neutropenia is 2% [2]. The potential for early diagnosis of bacteraemia through serum biomarkers has been the subject to extensive research [3]. In 2012 Phillips et al published large meta-analysis of 25 studies exploring 14 different biomarkers in 3,585 episodes of febrile neutropenia. CRP, PCT and IL-6 were subject to quantitative meta-analysis. The bivariate estimates of diagnostic precision of these biomarkers and outcomes were done. Data were available for meta-analysis for CRP for microbiologically or clinically documented infection (results: cut off > 50mg/dl, sensitivity 65%, specificity 73%), for PCT assessing microbiologically or clinically documented infection (results: cut off > 0.2 mg/ml, sensitivity 96%, specificity 85%), for IL-6 reporting microbiologically or clinically documented infection (results: cut off > 235 pg/ml, sensitivity 68%, specificity 94%), and gram-negative bacteraemia (results: cut off > 1000 pg/ml, sensitivity 78%, specificity 96%). Huge inconsistencies and heterogeneity in the studies included in this review were the most important limiting factors [...

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The predictive value of soluble biomarkers (CD14 subtype, interleukin-2 receptor, human leucocyte antigen-G) and procalcitonin in the detection of bacteremia and sepsis in pediatric oncology patients with chemotherapy-induced febrile neutropenia

Cited by 48 publications

References 15 publications

Role of presepsin for the evaluation of sepsis in the emergency department

Role of presepsin for the evaluation of sepsis in the emergency department

Diagnostic Accuracy of Presepsin (sCD14-ST) for Prediction of Bacterial Infection in Cerebrospinal Fluid Samples from Children with Suspected Bacterial Meningitis or Ventriculitis

The role of CRP, PCT, IL-6 and presepsin in early diagnosis of bacterial infectious complications in paediatric haemato-oncological patients

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