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

Öz

Purpose: Febrile neutropenia (FN) is a common side effect of chemotherapy in cancer patients, leading to complications, increased healthcare costs, and mortality. Microbiological agents can be identified in 30-50% of FN cases. Therefore, there is a need for specific, highly effective, and rapid markers to indicate infection. Various biomarkers are currently under investigation and in clinical use. This study aims to evaluate their effectiveness in the early detection of infection and mortality by comparing quantitative C-reactive protein (CRP) and procalcitonin levels at the onset of FN and during treatment. Material and methods: This study is a retrospective case-control study. It included 572 patients with febrile neutropenia (FN) who were followed up in the Hematology Clinic, Bone Marrow Transplantation Unit, and Medical Oncology Clinic between September 3, 2018, and May 25, 2022. A total of 748 FN episodes were recorded in these patients. Data were retrieved from the hospital information management system and documented using a pre-prepared form. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) 26.0 software. Results: Of the febrile neutropenia (FN) patients included in the study, 118 experienced mortality, whereas 630 survived. The mean age was 51.6 years in the mortality group and 50.5 years in the non-mortality group. Females constituted 47.9% of the cohort, while males accounted for 52.1%. Hematological malignancies were present in 67.2% of all patients. Bacteremia was identified in 36.5% of FN episodes. Although E. coli was the most frequently isolated microorganism, P. aeruginosa and A. baumannii were more commonly detected in patients who succumbed to the illness. Elevated C-reactive protein (CRP) and procalcitonin levels within the first five days of treatment were significantly associated with both mortality and the presence of bacteremia. Neither leukocyte count nor absolute neutrophil count at the time of diagnosis showed a significant association with mortality. However, prolonged duration of neutropenia, bloodstream infections, catheter-related bloodstream infections, and the presence of pneumonia emerged as significant risk factors for mortality. Conclusion: CRP and procalcitonin levels were observed to have both prognostic and diagnostic value. Additionally, resistant Gram-negative bacterial growth was more frequently detected in the blood cultures of patients who did not survive. Further studies are needed to develop new treatment algorithms.

Anahtar Kelimeler

• Febrile neutropenia
• C-reactive protein
• procalcitonin
• mortality

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

Öz

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 oranı %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.

Anahtar Kelimeler

• Febril nötropeni
• C-reaktif protein
• prokalsitonin
• mortalite

Kaynakça

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