Predictive values of serum amyloid-A (SAA) and C-reactive protein (CRP) for infection in febrile neutropenic cancer patients

Abstract

Objectives: To evaluate predictive values of serum amyloid A (SAA) and C-reactive protein (CRP) for infection and mor&shy;tality in patients with febrile neutropenia (FEN). Methods: Daily measurement of serum SAA and CRP levels of patients during antibiotherapy for FEN. Results: Sixty-five FEN episodes of 52 patients were evaluated. Median CRP and SAA levels on 1st day of FEN were 137 mg/L (23-420 mg/L) and 547 mg/L (11-1660 mg/L), respectively. For detection of infection of infection the sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of SAA at a level of >80 mg/L were as 100%, 48% and 100%. Whilethe sensitivity, PPV, and NPV of CRP at a level of >50mg/L were as 86%, 47% and 60%, respectively. Predictive values of initial SAA and CRP levels for infection didn\'t differ significantly (CRP: p=0.24, SAA: p=0.39). SAA and CRP levels on the last day of FEN course were significant for infection and mortality (for infection: p=0.003 for CRP and p=0.026 for SAA; for mortality: p<0.001 for CRP and p=0.021 for SAA). Both initial and daily SAA and CRP levels correlated with each other positively and statistically significantly (p<0.001). The area under the curve (AUC) on the re&shy;ceiver operating character (ROC) curve for CRP and SAA were 0.72 (p=0.003, 95% CI: 0.59-0.86) and 0.68 (p=0.19, 95% CI: 0.54-0.82), respectively. Conclusions: Despite low predictive values in decision of initial therapy, these parameters would be helpful in decision of modification and evaluation of response to therapy.

Keywords

• Fever, neutropenia, febrile neutropenia, C-reactive protein, serum amyloid A

Predictive values of serum amyloid-A (SAA) and C-reactive protein (CRP) for infection in febrile neutropenic cancer patients

Öz

Amaç: Febril nötropeni (FEN)si olan hastalarda serum amyloid A (SAA) ve C-reaktif protein (CRP)’in enfeksiyonun erken tanısı ve mortaliteyi öngörmede değerini incelemek Yöntemler: Antibiyoterapi sırasında hastaların serum SAA ve CRP düzeyleri günlük olarak ölçüldü. Bulgular: Elli-iki hastanın 65 FEN atağı incelendi. FEN tablosunun ilk günündeki medyan CRP ve SAA değerleri sırasıyla 137 mg/L (23-420 mg/L) ve 547 mg/L (11-1660 mg/L) idi. Enfeksiyonun tespitinde 80 mg/L üzerindeki SAA düzeyinin duyarlılığı 100%, pozitif prediktif değeri (PPD) ve negatif (NPD) prediktif değerleri sırasıyla %48 ve %100 idi. Enfeksiyonun tespitinde 50 mg/L üzerindeki CRP düzeyinin duyarlılığı %86, PPD ve NPD sırasıyla %47 ve %60 idi. Başlangıç SAA ve CRP düzeyleri arasında infeksiyonu öngörmede anlamlı fark saptanmadı (CRP için p=0,24, SAA için p=0,39). Ayrıca, febril atağın ilk gününden onikinci gününe kadarki günlük medyan SAA ve CRP değerleri arasında istatistiksel anlamlı bir korelasyon vardı (p<0,05). İzlemin son günündeki SAA ve CRP düzeyleri enfeksiyon ve mortalite açısından anlamlıydı (enfeksiyon varlığında CRP için p=0.003, SAA için p=0,026; mortalite varlığında CRP için p<0,001ve SAA için p=0,021). Hem başlangıç hem de günlük ölçülen SAA ve CRP değerleri birbirleriyle pozitif ve anlamlı korelasyon gösterdi (p<0.001). CRP ve SAA için ROC eğrisi altındaki alan sırasıyla 0,72 (p=0,003, %95 GA: 0,59-0,86) ve 0.68 (p=0,019, %95 GA: 0,54-0,82) idi. Sonuç: Başlangıç tedavi kararında öngörü değerleri düşük olmasına rağmen, bu parametreler tedavide değişiklik kararının alınmasında ve tedaviye yanıtın değerlendirilmesinde yararlı olabilir

Anahtar Kelimeler

• Ateş, nötropeni, febril nötropeni, C-reaktif protein, serum amyloid A

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