BibTex RIS Kaynak Göster

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

Yıl 2014, , 128 - 135, 01.12.2014
https://doi.org/10.5799/ahinjs.02.2014.04.0155

Öz

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.

Kaynakça

  • Quadri TL, Brown AE. Infectious complications in the critically ill patient with cancer. Semin Oncol 2000;27:335-346.
  • Ellis M. Febrile neutropenia. Ann N Y Acad Sci 2008;1138:329- 350.
  • Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52:e56-e93.
  • Sudhoff T, Giagounidis A, Karthaus M. Evaluation of neutrope- nic fever: value of serum and plasma parameters in clinical practice. Chemotherapy 2000;46:77-85.
  • Lehrnbecher T, Venzon D, de Haas M, et al. Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein, soluble Fc gamma receptor type III, and mannose-binding protein in febrile children with cancer and neutropenia. Clin Infect Dis 1999;29:414-419.
  • Engel A, Steinbach G, Kern P, Kern WV. Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis 1999;31:185-189.
  • Kern WV, Heiss M, Steinbach G. Prediction of gram-negative bacteremia in patients with cancer and febrile neutropenia by means of interleukin-8 levels in serum: targeting empiri- cal monotherapy versus combination therapy. Clin Infect Dis 2001;32:832-835.
  • Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, et al. As- sessment of procalcitonin as a diagnostic marker of underly- ing infection in patients with febrile neutropenia. Clin Infect Dis 2001;32:1718-1725.
  • Uys A, Rapoport BL, Fickl H, et al. Prediction of outcome in cancer patients with febrile neutropenia: comparison of the Multinational Association of Supportive Care in Cancer risk- index score with procalcitonin, C-reactive protein, serum am- yloid A, and interleukins-1beta, -6, -8 and -10. Eur J Cancer Care (Engl) 2007;16:475-483.
  • Persson L, Soderquist B, Engervall P, et al. Assessment of systemic inflammation markers to differentiate a stable from a deteriorating clinical course in patients with febrile neutro- penia. Eur J Haematol 2005;74:297-303.
  • Wang CS, Sun CF. C-reactive protein and malignancy: clinico-pathological association and therapeutic implication. Chang Gung Med J 2009;32:471-482.
  • Kanoh Y, Abe T, Masuda N, Akahoshi T. Progression of non- small cell lung cancer: diagnostic and prognostic utility of matrix metalloproteinase-2, C-reactive protein and serum amyloid A. Oncol Rep 2013;29:469-473.
  • Eklund KK, Niemi K, Kovanen PT. Immune functions of se- rum amyloid A. Crit Rev Immunol 2012;32:335-348.
  • Fischer K, Theil G, Hoda R, Fornara P. Serum amyloid A: a biomarker for renal cancer. Anticancer Res 2012;32:1801- 1804.
  • Gencer S, Salepci T, Ozer S. Evaluation of infectious etiology and prognostic risk factors of febrile episodes in neutropenic cancer patients. J Infect 2003;47:65-72.
  • Hollen PJ, Gralla RJ, Kris MG, et al. Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies. Psychometric assessment of the Lung Cancer Symptom Scale. Cancer 1994;73:2087-2098.
  • Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin On- col 1984;2:187-193.
  • Karan MA. Predictive value of higher plasma interleukin-6 levels in patients with febrile neutropenia. Arch Med Res 2002;33:557-561.
  • Engervall P, Granstrom M, Andersson B, Bjorkholm M. Moni- toring of endotoxin, interleukin-6 and C-reactive protein se- rum concentrations in neutropenic patients with fever. Eur J Haematol 1995;54:226-234.
  • Manian FA. A prospective study of daily measurement of C- reactive protein in serum of adults with neutropenia. Clin In- fect Dis 1995;21:114-121.
  • Yonemori K, Kanda Y, Yamamoto R, et al. Clinical value of serial measurement of serum C-reactive protein level in neu- tropenic patients. Leuk Lymphoma 2001;41:607-614.
  • Yamada T. Serum amyloid A (SAA): a concise review of biol- ogy, assay methods and clinical usefulness. Clin Chem Lab Med 1999;37:381-388.
  • Schultz DR, Arnold PI. Properties of four acute phase pro- teins: C-reactive protein, serum amyloid A protein, alpha 1-acid glycoprotein, and fibrinogen. Semin Arthritis Rheum 1990;20:129-147.
  • Casl MT, Sabljar-Matovinovic M, Kovacevic S, et al. Clinical relevance of serum amyloid A protein monitoring in urinary tract infections. Ann Clin Biochem 1993;30 ( Pt 3):272-277.
  • Marhaug G, Permin H, Husby G. Amyloid-related serum pro- tein (SAA) as an indicator of lung infection in cystic fibrosis. Acta Paediatr Scand 1983;72:861-866.
  • Miwata H, Yamada T, Okada M, Kudo T, Kimura H, Morishima T. Serum amyloid A protein in acute viral infections. Arch Dis Child 1993;68:210-214.
  • Nakayama T, Sonoda S, Urano T, et al. Monitoring both se- rum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases. Clin Chem 1993;39:293-297.
  • Riikonen P, Saarinen UM, Teppo AM, et al. Cytokine and acute-phase reactant levels in serum of children with cancer admitted for fever and neutropenia. J Infect Dis 1992;166:432-436.

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

Yıl 2014, , 128 - 135, 01.12.2014
https://doi.org/10.5799/ahinjs.02.2014.04.0155

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

Kaynakça

  • Quadri TL, Brown AE. Infectious complications in the critically ill patient with cancer. Semin Oncol 2000;27:335-346.
  • Ellis M. Febrile neutropenia. Ann N Y Acad Sci 2008;1138:329- 350.
  • Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52:e56-e93.
  • Sudhoff T, Giagounidis A, Karthaus M. Evaluation of neutrope- nic fever: value of serum and plasma parameters in clinical practice. Chemotherapy 2000;46:77-85.
  • Lehrnbecher T, Venzon D, de Haas M, et al. Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein, soluble Fc gamma receptor type III, and mannose-binding protein in febrile children with cancer and neutropenia. Clin Infect Dis 1999;29:414-419.
  • Engel A, Steinbach G, Kern P, Kern WV. Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis 1999;31:185-189.
  • Kern WV, Heiss M, Steinbach G. Prediction of gram-negative bacteremia in patients with cancer and febrile neutropenia by means of interleukin-8 levels in serum: targeting empiri- cal monotherapy versus combination therapy. Clin Infect Dis 2001;32:832-835.
  • Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, et al. As- sessment of procalcitonin as a diagnostic marker of underly- ing infection in patients with febrile neutropenia. Clin Infect Dis 2001;32:1718-1725.
  • Uys A, Rapoport BL, Fickl H, et al. Prediction of outcome in cancer patients with febrile neutropenia: comparison of the Multinational Association of Supportive Care in Cancer risk- index score with procalcitonin, C-reactive protein, serum am- yloid A, and interleukins-1beta, -6, -8 and -10. Eur J Cancer Care (Engl) 2007;16:475-483.
  • Persson L, Soderquist B, Engervall P, et al. Assessment of systemic inflammation markers to differentiate a stable from a deteriorating clinical course in patients with febrile neutro- penia. Eur J Haematol 2005;74:297-303.
  • Wang CS, Sun CF. C-reactive protein and malignancy: clinico-pathological association and therapeutic implication. Chang Gung Med J 2009;32:471-482.
  • Kanoh Y, Abe T, Masuda N, Akahoshi T. Progression of non- small cell lung cancer: diagnostic and prognostic utility of matrix metalloproteinase-2, C-reactive protein and serum amyloid A. Oncol Rep 2013;29:469-473.
  • Eklund KK, Niemi K, Kovanen PT. Immune functions of se- rum amyloid A. Crit Rev Immunol 2012;32:335-348.
  • Fischer K, Theil G, Hoda R, Fornara P. Serum amyloid A: a biomarker for renal cancer. Anticancer Res 2012;32:1801- 1804.
  • Gencer S, Salepci T, Ozer S. Evaluation of infectious etiology and prognostic risk factors of febrile episodes in neutropenic cancer patients. J Infect 2003;47:65-72.
  • Hollen PJ, Gralla RJ, Kris MG, et al. Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies. Psychometric assessment of the Lung Cancer Symptom Scale. Cancer 1994;73:2087-2098.
  • Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin On- col 1984;2:187-193.
  • Karan MA. Predictive value of higher plasma interleukin-6 levels in patients with febrile neutropenia. Arch Med Res 2002;33:557-561.
  • Engervall P, Granstrom M, Andersson B, Bjorkholm M. Moni- toring of endotoxin, interleukin-6 and C-reactive protein se- rum concentrations in neutropenic patients with fever. Eur J Haematol 1995;54:226-234.
  • Manian FA. A prospective study of daily measurement of C- reactive protein in serum of adults with neutropenia. Clin In- fect Dis 1995;21:114-121.
  • Yonemori K, Kanda Y, Yamamoto R, et al. Clinical value of serial measurement of serum C-reactive protein level in neu- tropenic patients. Leuk Lymphoma 2001;41:607-614.
  • Yamada T. Serum amyloid A (SAA): a concise review of biol- ogy, assay methods and clinical usefulness. Clin Chem Lab Med 1999;37:381-388.
  • Schultz DR, Arnold PI. Properties of four acute phase pro- teins: C-reactive protein, serum amyloid A protein, alpha 1-acid glycoprotein, and fibrinogen. Semin Arthritis Rheum 1990;20:129-147.
  • Casl MT, Sabljar-Matovinovic M, Kovacevic S, et al. Clinical relevance of serum amyloid A protein monitoring in urinary tract infections. Ann Clin Biochem 1993;30 ( Pt 3):272-277.
  • Marhaug G, Permin H, Husby G. Amyloid-related serum pro- tein (SAA) as an indicator of lung infection in cystic fibrosis. Acta Paediatr Scand 1983;72:861-866.
  • Miwata H, Yamada T, Okada M, Kudo T, Kimura H, Morishima T. Serum amyloid A protein in acute viral infections. Arch Dis Child 1993;68:210-214.
  • Nakayama T, Sonoda S, Urano T, et al. Monitoring both se- rum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases. Clin Chem 1993;39:293-297.
  • Riikonen P, Saarinen UM, Teppo AM, et al. Cytokine and acute-phase reactant levels in serum of children with cancer admitted for fever and neutropenia. J Infect Dis 1992;166:432-436.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Makaleler
Yazarlar

Ayse Batirel Bu kişi benim

Serap Gençer Bu kişi benim

Serdar Özer Bu kişi benim

Taflan Salepçi Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2014
Yayımlandığı Sayı Yıl 2014

Kaynak Göster

APA Batirel, A., Gençer, S., Özer, S., Salepçi, T. (2014). Predictive values of serum amyloid-A (SAA) and C-reactive protein (CRP) for infection in febrile neutropenic cancer patients. Journal of Microbiology and Infectious Diseases, 4(04), 128-135. https://doi.org/10.5799/ahinjs.02.2014.04.0155
AMA Batirel A, Gençer S, Özer S, Salepçi T. Predictive values of serum amyloid-A (SAA) and C-reactive protein (CRP) for infection in febrile neutropenic cancer patients. J Microbil Infect Dis. Aralık 2014;4(04):128-135. doi:10.5799/ahinjs.02.2014.04.0155
Chicago Batirel, Ayse, Serap Gençer, Serdar Özer, ve Taflan Salepçi. “Predictive Values of Serum Amyloid-A (SAA) and C-Reactive Protein (CRP) for Infection in Febrile Neutropenic Cancer Patients”. Journal of Microbiology and Infectious Diseases 4, sy. 04 (Aralık 2014): 128-35. https://doi.org/10.5799/ahinjs.02.2014.04.0155.
EndNote Batirel A, Gençer S, Özer S, Salepçi T (01 Aralık 2014) Predictive values of serum amyloid-A (SAA) and C-reactive protein (CRP) for infection in febrile neutropenic cancer patients. Journal of Microbiology and Infectious Diseases 4 04 128–135.
IEEE A. Batirel, S. Gençer, S. Özer, ve T. Salepçi, “Predictive values of serum amyloid-A (SAA) and C-reactive protein (CRP) for infection in febrile neutropenic cancer patients”, J Microbil Infect Dis, c. 4, sy. 04, ss. 128–135, 2014, doi: 10.5799/ahinjs.02.2014.04.0155.
ISNAD Batirel, Ayse vd. “Predictive Values of Serum Amyloid-A (SAA) and C-Reactive Protein (CRP) for Infection in Febrile Neutropenic Cancer Patients”. Journal of Microbiology and Infectious Diseases 4/04 (Aralık 2014), 128-135. https://doi.org/10.5799/ahinjs.02.2014.04.0155.
JAMA Batirel A, Gençer S, Özer S, Salepçi T. Predictive values of serum amyloid-A (SAA) and C-reactive protein (CRP) for infection in febrile neutropenic cancer patients. J Microbil Infect Dis. 2014;4:128–135.
MLA Batirel, Ayse vd. “Predictive Values of Serum Amyloid-A (SAA) and C-Reactive Protein (CRP) for Infection in Febrile Neutropenic Cancer Patients”. Journal of Microbiology and Infectious Diseases, c. 4, sy. 04, 2014, ss. 128-35, doi:10.5799/ahinjs.02.2014.04.0155.
Vancouver Batirel A, Gençer S, Özer S, Salepçi T. Predictive values of serum amyloid-A (SAA) and C-reactive protein (CRP) for infection in febrile neutropenic cancer patients. J Microbil Infect Dis. 2014;4(04):128-35.