Sepsis biomarkers in neutropaenic systemic inflammatory response syndrome patients on standard care wards

被引:16
作者
Ratzinger, Franz [1 ]
Haslacher, Helmuth [1 ]
Perkmann, Thomas [1 ]
Schmetterer, Klaus G. [1 ]
Poeppl, Wolfgang [2 ]
Mitteregger, Dieter [3 ]
Dorffner, Georg [4 ]
Burgmann, Heinz [2 ]
机构
[1] Med Univ Vienna, Div Med & Chem Lab Diagnost, Dept Lab Med, A-1090 Vienna, Austria
[2] Med Univ Vienna, Div Infect Dis & Trop Med, Dept Med 1, A-1090 Vienna, Austria
[3] Med Univ Vienna, Div Clin Microbiol, Dept Lab Med, A-1090 Vienna, Austria
[4] Med Univ Vienna, Sect Artificial Intelligence, Ctr Med Stat Informat & Intelligent Syst, A-1090 Vienna, Austria
关键词
Infection; lipopolysaccharide-binding protein; neutropaenia; procalcitonin; propensity score; sepsis; LIPOPOLYSACCHARIDE-BINDING PROTEIN; C-REACTIVE PROTEIN; NEUTROPENIC PATIENTS; DIAGNOSTIC MARKER; PROCALCITONIN; BACTEREMIA; RISK; SERUM; INTERLEUKIN-6; CHEMOTHERAPY;
D O I
10.1111/eci.12476
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundNeutropaenic patients are at a high risk of contracting severe infections. In particular, in these patients, parameters with a high negative predictive value are desirable for excluding infection or bacteraemia. This study evaluated sepsis biomarkers in neutropaenic patients suffering from systemic inflammatory response syndrome (SIRS). Further, the predictive capacities of evaluated biomarkers in neutropaenic SIRS patients were compared to non-neutropaenic SIRS patients. Material and methodsIn this prospective observational cohort study, patients with clinically suspected sepsis were screened. The predictive capacities of procalcitonin (PCT), C-reactive protein and lipopolysaccharide-binding protein (LBP) in neutropaenic SIRS patients were evaluated in terms of their potential to identify infection or bacteraemia and were compared to results for non-neutropaenic SIRS patients. To select an appropriate control cohort, propensity score matching was applied, balancing confounding factors between neutropaenic and non-neutropaenic SIRS patients. ResultsOf 3370 prospectively screened patients with suspected infection, 51 patients suffered from neutropaenic SIRS. For the identification of infection, none of the assessed biomarkers presented a clinically relevant discriminatory potency. Lipopolysaccharide-binding protein and PCT demonstrated discriminatory capacity to discriminate between nonbacteraemic and bacteraemic SIRS in patients with neutropaenia [receiver-operating characteristics-area under the curves (ROC-AUCs): 0860, 0818]. In neutropaenic SIRS patients, LBP had a significantly better ROC-AUC than in a comparable non-neutropaenic patient cohort for identifying bacteraemia (P=001). ConclusionIn neutropaenic SIRS patients, none of the evaluated biomarkers was able to adequately identify infection. LBP and PCT presented a good performance in identifying bacteraemia. Therefore, these markers could be used for screening purposes to increase the pretest probability of blood culture analysis.
引用
收藏
页码:815 / 823
页数:9
相关论文
共 40 条
[1]   Clinical and economic impact of contaminated blood cultures within the hospital setting [J].
Alahmadi, Y. M. ;
Aldeyab, M. A. ;
McElnay, J. C. ;
Scott, M. G. ;
Elhajji, F. W. Darwish ;
Magee, F. A. ;
Dowds, M. ;
Edwards, C. ;
Fullerton, L. ;
Tate, A. ;
Kearney, M. P. .
JOURNAL OF HOSPITAL INFECTION, 2011, 77 (03) :233-236
[2]  
[Anonymous], PPS PROT COD V4 3 IN
[3]  
[Anonymous], 2005, R LANG ENV STAT COMP
[4]   CONTAMINANT BLOOD CULTURES AND RESOURCE UTILIZATION - THE TRUE CONSEQUENCES OF FALSE-POSITIVE RESULTS [J].
BATES, DW ;
GOLDMAN, L ;
LEE, TH .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 265 (03) :365-369
[5]   DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS [J].
BONE, RC ;
BALK, RA ;
CERRA, FB ;
DELLINGER, RP ;
FEIN, AM ;
KNAUS, WA ;
SCHEIN, RMH ;
SIBBALD, WJ .
CHEST, 1992, 101 (06) :1644-1655
[6]   Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction [J].
Castelli, GP ;
Pognani, C ;
Meisner, M ;
Stuani, A ;
Bellomi, D ;
Sgarbi, L .
CRITICAL CARE, 2004, 8 (04) :R234-R242
[7]   Low serum procalcitonin level accurately predicts the absence of bacteremia in adult patients with acute fever [J].
Chirouze, C ;
Schuhmacher, H ;
Rabaud, C ;
Gil, H ;
Khayat, N ;
Estavoyer, JM ;
May, T ;
Hoen, B .
CLINICAL INFECTIOUS DISEASES, 2002, 35 (02) :156-161
[8]   Does This Adult Patient With Suspected Bacteremia Require Blood Cultures? [J].
Coburn, Bryan ;
Morris, Andrew M. ;
Tomlinson, George ;
Detsky, Allan S. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2012, 308 (05) :502-511
[9]   Production of the acute-phase protein lipopolysaccharide-binding protein by respiratory type II epithelial cells - Implications for local defense to bacterial endotoxins [J].
Dentener, MA ;
Vreugdenhil, ACE ;
Hoet, PHM ;
Vernooy, JHJ ;
Nieman, FHM ;
Heumann, D ;
Janssen, YMW ;
Buurman, WA ;
Wouters, EFM .
AMERICAN JOURNAL OF RESPIRATORY CELL AND MOLECULAR BIOLOGY, 2000, 23 (02) :146-153
[10]   Body mass index and the risk of infections in institutionalised geriatric patients [J].
Dorner, Thomas E. ;
Schwarz, Franz ;
Kranz, Alexander ;
Freidl, Wolfgang ;
Rieder, Anita ;
Gisinger, Christoph .
BRITISH JOURNAL OF NUTRITION, 2010, 103 (12) :1830-1835