Franz Ratzinger1, Helmuth Haslacher1, Thomas Perkmann1, Klaus G Schmetterer1, Wolfgang Poeppl2, Dieter Mitteregger3, Georg Dorffner4, Heinz Burgmann2. 1. Division of Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria. 2. Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria. 3. Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria. 4. Section for Artificial Intelligence, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: Neutropaenic 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 METHODS: In 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. RESULTS: Of 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): 0.860, 0.818]. In neutropaenic SIRS patients, LBP had a significantly better ROC-AUC than in a comparable non-neutropaenic patient cohort for identifying bacteraemia (P = 0.01). CONCLUSION: In 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.
BACKGROUND: Neutropaenic 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 SIRSpatients. MATERIAL AND METHODS: In 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 SIRSpatients. To select an appropriate control cohort, propensity score matching was applied, balancing confounding factors between neutropaenic and non-neutropaenic SIRSpatients. RESULTS: Of 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): 0.860, 0.818]. In neutropaenic SIRS patients, LBP had a significantly better ROC-AUC than in a comparable non-neutropaenic patient cohort for identifying bacteraemia (P = 0.01). CONCLUSION: In 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.
Authors: Russell R Miller; Bert K Lopansri; John P Burke; Mitchell Levy; Steven Opal; Richard E Rothman; Franco R D'Alessio; Venkataramana K Sidhaye; Neil R Aggarwal; Robert Balk; Jared A Greenberg; Mark Yoder; Gourang Patel; Emily Gilbert; Majid Afshar; Jorge P Parada; Greg S Martin; Annette M Esper; Jordan A Kempker; Mangala Narasimhan; Adey Tsegaye; Stella Hahn; Paul Mayo; Tom van der Poll; Marcus J Schultz; Brendon P Scicluna; Peter Klein Klouwenberg; Antony Rapisarda; Therese A Seldon; Leo C McHugh; Thomas D Yager; Silvia Cermelli; Dayle Sampson; Victoria Rothwell; Richard Newman; Shruti Bhide; Brian A Fox; James T Kirk; Krupa Navalkar; Roy F Davis; Roslyn A Brandon; Richard B Brandon Journal: Am J Respir Crit Care Med Date: 2018-10-01 Impact factor: 21.405
Authors: Franz Ratzinger; Helmuth Haslacher; Markus Stadlberger; Ralf L J Schmidt; Markus Obermüller; Klaus G Schmetterer; Thomas Perkmann; Athanasios Makristathis; Rodrig Marculescu; Heinz Burgmann Journal: Sci Rep Date: 2017-01-12 Impact factor: 4.379
Authors: Sigrid Bülow; Robert Heyd; Martina Toelge; Katharina U Ederer; Annette Schweda; Stefan H Blaas; Okka W Hamer; Andreas Hiergeist; Jürgen J Wenzel; André Gessner Journal: J Fungi (Basel) Date: 2020-11-20
Authors: Luis García de Guadiana-Romualdo; Pablo Cerezuela-Fuentes; Ignacio Español-Morales; Patricia Esteban-Torrella; Enrique Jiménez-Santos; Ana Hernando-Holgado; María Dolores Albaladejo-Otón Journal: Biochem Med (Zagreb) Date: 2018-12-15 Impact factor: 2.313