Evaluation of c-reactive protein and procalcitonin as a mortality indicator in febrile neutropenic patients

Year 2025, Volume: 18 Issue: 3, 4 - 4

Hasan Öksüzoğlu , Duygu Mert , Gülşen İskender , Nagihan Ulu Demirci Mustafa Ertek

https://doi.org/10.31362/patd.1552581

Abstract

Purpose: Febrile neutropenia (FN) develops as a side effect of chemotherapeutics in cancer patients. It causes complications, increased cost, and mortality. Microbiological agents can be detected in 30-50% of FN. Therefore, specific, highly effective, and rapid markers that can indicate infection are needed. Various biomarkers are under investigation and are still in use today. In this study, it was aimed to evaluate their effectiveness in early detection of infection and mortality by comparing quantitative C-reactive protein (CRP) and procalcitonin values at the beginning of FN and during treatment.
Material and methods: This research is a retrospective, case-control study. The study included 572 FN patients who were followed up in the Hematology Clinic, Bone Marrow Transplantation Unit and Medical Oncology Clinic between 3 September 2018 and 25 May 2022. 748 FN attacks developed in these patients. The hospital information management system was analysed, and the data of the patients were recorded in the pre-prepared form. Data were analysed using ‘The Package for Social Sciences 26.0’ statistical program.
Results: 49.1% of FN cases were female and 50.9% male. Hematological malignancy was detected in 60.8% of the patients. Mortality developed in 118 (20.6%) patients. The rate of bacteremia in FN attacks was 36.5%. The most common causative microorganism was Escherichia coli. Pseudomonas aeruginosa and Acinetobacter baumannii were more common in patients with mortality. CRP and procalcitonin values in the first five days of treatment were higher in patients with bacteremia and mortality. Prolonged neutropenia and bloodstream infection were found to be risk factors for mortality.
Conclusion: It has been observed that CRP and procalcitonin values can be used both prognostically and diagnostically. It was found that resistant Gram-negative bacteria growth was higher in blood cultures of patients with mortality. More studies are needed to develop new treatment algorithms.

Keywords

Febrile neutropenia, C-reactive protein, procalcitonin, mortality

Febril nötropenik hastalarda c-reaktif protein ve prokalsitoninin mortalite göstergesi olarak değerlendirilmesi

Abstract

Giriş: FN, kemoterapötiklerin komplikasyonlara, maliyet artışı ve mortaliteye yol açabilen yan etkisidir. Enfeksiyon hastalıklarının sadece %30-50’sinde ateşin kaynağı ve mikrobiyolojik etkenler saptanabilmektedir. Bu nedenle enfeksiyonu gösterebilecek, spesifik, yüksek etkinlikli ve hızlı belirteçlere ihtiyaç duyulmaktadır. Bu nedenle çeşitli biyomarkerlar araştırılmakta ve günümüzde halen kullanılmaktadır. Çalışmamızda da nötropenik ateşte CRP ve prokalsitoninin tanısal, prognostik kullanılabileceği ve FN ataklarının klinik, laboratuvar özelliklerinin, kültürde üreyen mikroorganizmaların araştırılması amaçlanmıştır.
Gereç ve yöntem: Retrospektif, vaka – kontrol çalışması olarak yürütülen bu çalışma 3 Eylül 2018–25 Mayıs 2022 tarihleri arasında hematoloji, kemik iliği transplantasyon ve tıbbi onkoloji kliniğinde FN sebebiyle tedavi gören 18 yaş ve üstü hastalarda gelişen 748 FN atağı irdelendi. Hastane bilgi yönetim sistemi taranarak uygun olan hastalar veri formuna kaydedilerek The Package for Social Sciences 26.0 (SPSS 26.0) aracılığıyla analiz edildi.
Bulgular: Çalışmaya dahil edilen FN hastalarından 118 tanesinde mortalite gelişmişken, 630 tanesinde mortalite gelişmemiştir. Mortalite grubunda yaş ortalaması 51,6, mortalite olmayan grupta ise 50,5 bulunmuştur. Hastaların %47,9’unu kadın, %52,1’ini erkek hastalar oluşturmaktadır. Hastaların %67,2’sinin hematolojik malignitesi mevcuttu. FN ataklarında bakteriyemi oranu %36,5 bulundu ve en sık saptanan mikroorganizma E. coli olmasına rağmen P. aeruginosa ve A. baumannii üremesi olanlar mortalitesi olanlarda daha yüksek saptanmıştır. Tedavinin ilk beş gününde bakılan CRP ve prokalsitonin değeri mortalite ve bakteriyemisi olan hastalarda yüksek bulunmuştur. Tanı anında lökosit ve nötrofil sayısının mortaliteye etkisi olmadığı saptandı. Nötropeni süresi uzaması, kandolaşım enfeksiyonu, kateter ilişkili kandolaşım enfeksiyonu ve pnömoni varlığı mortalite açısından risk faktörü olarak saptanmıştır.
Sonuç: CRP ve prokalsitonin değerlerinin mortalite göstergesi olarak değerlendirildiği çalışmamızda hem prognostik hem de tanısal olarak kullanılabileceği öngörülmüştür. Mortalitesi olan hastalarda dirençli gram-negatif mikroorganizmaların daha hakim olduğu saptanmış olup yeni tedavi algoritmalarının geliştirilmesi için daha çok çalışmaya gereksinim duyulmaktadır.

Keywords

Febril nötropeni, c-reaktif protein, prokalsitonin, mortalite

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