scholarly journals C-Reactive Protein Monitoring and Clinical Presentation of Fever as Predictive Factors of Prolonged Febrile Neutropenia and Blood Culture Positivity after Autologous Hematopoietic Stem Cell Transplantation—Single-Center Real-Life Experience

2022 ◽  
Vol 11 (2) ◽  
pp. 312
Author(s):  
Daniela Carcò ◽  
Uros Markovic ◽  
Paolo Castorina ◽  
Valeria Iachelli ◽  
Tecla Pace ◽  
...  

Background: Febrile neutropenia (FN) is a medical emergency that requires urgent evaluation, timely administration of empiric broad-spectrum antibiotics and careful monitoring in order to optimize the patient’s outcome, especially in the setting of both allogeneic and autologous hematopoietic stem cell transplant (ASCT). Methods: In this real-life retrospective study, a total of 49 consecutive episodes of FN were evaluated in 40 adult patients affected by either multiple myeloma (thirty-eight) or lymphoma (eleven), following ASCT, with nine patients having fever in both of the tandem transplantations. Results: Febrile neutropenia occurred a median of 7 days from ASCT. Median duration of FN was 2 days, with 25% of population that had fever for at least four days. Ten patients had at least one fever spike superior to 39 °C, while the median number of daily fever spikes was two. Twenty patients had positive blood cultures with XDR germs, namely Pseudomonas aeruginosa and Klebsiella pneumoniae, present in seven cases. ROC analysis of peak C-reactive protein (CRP) values was conducted based on blood culture positivity and a value of 12 mg/dL resulted significant. Onset of prolonged fever with a duration greater than 3 days was associated with the presence of both a peak number of three or more daily fever spikes (p = 0.02) and a body temperature greater than 39 °C (p = 0.04) based on odds ratio (OR). Blood culture positivity and peak CRP values greater than 12 mg/dL were also associated with prolonged fever duration, p = 0.04, and p = 0.03, respectively. The probability of blood culture positivity was also greater in association with fever greater than 39 °C (p = 0.04). Furthermore, peak CRP values below the cut-off showed less probability of positive blood culture (p = 0.02). Conclusions: In our study, clinical characteristics of fever along with peak CRP levels were associated with a higher probability of both prolonged fever duration and positive blood culture, needing extended antibiotic therapy.

2015 ◽  
Vol 21 ◽  
pp. 99-108
Author(s):  
Al Jahidi Hasan Chowdhurya ◽  
M Shahjahana ◽  
Tanzima Yeasmin ◽  
Mohammad Shariar Shovona ◽  
M Mushfequr Rahman

Context: Neonatal sepsis is one of the most important causes of morbidity and mortality and C-reactive protein (CRP) an excellent biomarker has significant diagnostic and prognostic value for the treatment of septicemia patient. Objectives: To isolate and identify viable pathogens from blood culture and their antibiogram and to correlate CRP levels with septicemic child. Materials and Methods: A total of 273 cases among which 233 were clinically suspected septicemia cases and 40 were healthy controls in age group 0 day to 15 years were selected from United Hospital Ltd., Dhaka Bangladesh. Blood culture was analyzed by the instrument BACTEC 9120 series. CRP was measured from blood serum by the auto biochemical analyzer OLYMPUS AU 640 followed by immuno-turbidimetric method. The organisms were isolated by inoculation on blood agar and MacConkey agar media. Identification of the organisms was done by colony morphology, gram staining and biochemical tests. Sensitivity of isolates was done against antimicrobial agents by disc diffusing method. Results: Blood samples in total 233 cases of suspected septicemia in children were studied between the ages of 0 day to 15 years. Culture proven septicemia 39 (16.74%), probable septicemia 136 (58.37%) and nonsepticemic febrile patients 58 (24.90%) were found. The highest rate of blood culture positivity found among 5-10 yrs. age group (25.64%). Salmonella typhi (41.03%) was the most common infective agent. The rate of blood culture positivity was significantly higher (p<0.001) among patients without antimicrobial therapy (23.74%) than those in patients with antimicrobial therapy (6.38%). S. typhi were 75% sensitive to Ceftriaxone while azithromycin showed high rate resistance (85.71%). E. coli and Klebsiella pneumoniae were highly sensitive (100%) to imipenem but E. coli resistant (100%) to amikacin, amoxyclavonic acid ciprofloxacin, gentamicin, Cefepime and netilmicin. Resistant (100%) to gentamicin was observed from K. pneumoniae. Mean CRP values (mg/l) of blood culture proven septicemia group, probable septicemia group, non-septicemic febrile group and control group were 70.42, 34.05, 3.08 and 0.98 respectively. Both proven septicemia and suspected septicemia cases showed CRP concentration above the cut-off value (>6 mg/l) and p value significant (p<0.001). Statistically significant difference (p<0.001) was found when mean CRP level of proven septicemia group, probable septicemia group and non-septicemic febrile group each compared with control group. CRP concentration were significantly (p < 0.001) different among three study group. Conclusion: Most of the gram negative bacteria isolated from blood culture showed resistance to commonly used antibiotics. The predominant infective isolate was Salmonella typhi. In this study, CRP level is high (cut-off value 6 mg/l) both in proven and probable septicemia group. CRP may have a good biomarker tools in diagnostic and prognostic value. Investigation of blood culture should be done before antimicrobial therapy, DOI: http://dx.doi.org/10.3329/jbs.v21i0.22524 J. bio-sci. 21: 99-108, 2013


Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1879 ◽  
Author(s):  
Anitra C. Carr ◽  
Emma Spencer ◽  
Andrew Das ◽  
Natalie Meijer ◽  
Carolyn Lauren ◽  
...  

Patients undergoing myeloablative chemotherapy and hematopoietic stem cell transplantation (HSCT) experience profound neutropenia and vulnerability to infection. Previous research has indicated that patients with infections have depleted vitamin C status. In this study, we recruited 38 patients with hematopoietic cancer who were undergoing conditioning chemotherapy and HSCT. Blood samples were collected prior to transplantation, at one week, two weeks and four weeks following transplantation. Vitamin C status and biomarkers of inflammation (C-reactive protein) and oxidative stress (protein carbonyls and thiobarbituric acid reactive substances) were assessed in association with febrile neutropenia. The vitamin C status of the study participants decreased from 44 ± 7 µmol/L to 29 ± 5 µmol/L by week one (p = 0.001) and 19 ± 6 µmol/L by week two (p < 0.001), by which time all of the participants had undergone a febrile episode. By week four, vitamin C status had increased to 37 ± 10 µmol/L (p = 0.1). Pre-transplantation, the cohort comprised 19% with hypovitaminosis C (i.e., <23 µmol/L) and 8% with deficiency (i.e., <11 µmol/L). At week one, those with hypovitaminosis C had increased to 38%, and at week two, 72% had hypovitaminosis C, and 34% had outright deficiency. C-reactive protein concentrations increased from 3.5 ± 1.8 mg/L to 20 ± 11 mg/L at week one (p = 0.002), and 119 ± 25 mg/L at week two (p < 0.001), corresponding to the development of febrile neutropenia in the patients. By week four, these values had dropped to 17 ± 8 mg/L (p < 0.001). There was a significant inverse correlation between C-reactive protein concentrations and vitamin C status (r = −0.424, p < 0.001). Lipid oxidation (thiobarbituric acid reactive substances (TBARS)) increased significantly from 2.0 ± 0.3 µmol/L at baseline to 3.3 ± 0.6 µmol/L by week one (p < 0.001), and remained elevated at week two (p = 0.003), returning to baseline concentrations by week four (p = 0.3). Overall, the lowest mean vitamin C values (recorded at week two) corresponded with the highest mean C-reactive protein values and lowest mean neutrophil counts. Thus, depleted vitamin C status in the HSCT patients coincides with febrile neutropenia and elevated inflammation and oxidative stress.


2006 ◽  
Vol 76 (2) ◽  
pp. 93-101 ◽  
Author(s):  
Markus Pihusch ◽  
Rudolf Pihusch ◽  
Peter Fraunberger ◽  
Verena Pihusch ◽  
Reinhard Andreesen ◽  
...  

JBMTCT ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. p44
Author(s):  
Bruna Sabioni ◽  
Eduardo Edelman Saul ◽  
Rodrigo Portugal ◽  
Marcia Rejane Valentim ◽  
Angelo Maiolino ◽  
...  

Objective: The aim of this study was to evaluate C-reactive protein (CRP) as a predictor of complications during autologous stem cell transplant (HSCT). Methods: We analyzed a cohort of 340 transplants. Correlation analyses were performed, including CRP obtained before HSCT, on Day+3, Day+6, Day+9, after Day+11, and at the onset of febrile neutropenia, and the following outcomes: bacteremia, severity of mucositis, length of neutropenia and hospitalization, and death. Results: the median age was 54 years old (ranging from 20 to 75), and 62% and 20% were multiple myeloma and non-Hodgkin lymphoma cases, respectively.  The median CRP levels increased from D+3 to D+9 and after that decreased progressively until discharge. CRP levels were associated with bacteremia, mucositis grade, length of neutropenia and hospitalization, and death. Variation in CRP values from D+3 to D+6 predicted complications. Mortality was associated with D+9 CRP levels (19 vs. 7.9 mg/dL; p<0.01), and a ROC curve area of 0.83 (95% CI 0.7 – 0.95) to predict mortality. At a cut-off of 8.5mg/dL, D+9 CRP had 83% and 79% sensitivity and specificity, respectively. Conclusions: In this study, CRP dynamics were associated with several HSCT complications. CRP levels curve could be applied to indicate poor outcomes during HSCT.


2020 ◽  
Vol 9 (2) ◽  
pp. 40-46
Author(s):  
Sachin Punatar ◽  
Lingaraj Nayak ◽  
Avinash Bonda ◽  
Anant Gokarn ◽  
Aniket Mohite ◽  
...  

Engraftment fever (EF) is a common complication of autologous HSCT (AHSCT). It is difficult to discern it from infectious fever (IF). We studied the significance of total blood leucocyte count (TLC) to C-reactive protein (CRP) ratio in differentiating EF from IF. 109 consecutive AHSCT patients were retrospectively analysed between March 2011 and August 2013. Breakthrough fever (BF) was defined as new-onset fever preceded by an afebrile period of at least 48 hours. The BF episodes were classified as IF or EF. Infectious fever was diagnosed in case of blood culture positivity, radiological signs of infection, or fever subsiding within 48 hours of changing the antibiotics. Engraftment fever was defined in cases associated with rising leucocyte counts without identifiable infective focus. EF responded well to steroid therapy. Daily TLC and CRP values were obtained from patients’ records. Optimal cut-off value of ratio on day of BF was obtained by plotting ROC curve. Sensitivity and specificity were calculated at this value. Among 109 cases, the breakthrough fever manifested in seventy patients. The median term for BF was day +9. Sixty-two patients had the EF. Median value of TLC/CRP ratio on the day of BF was significantly higher in patients with EF than with IF (0.139 vs 0.038, p=0.013). With ROC analysis, the AUC value was 0.78 (95%CI – 0.66-0.89, p<0.0001). The ROC curve provided the optimal TLC/CRP value of 0.056. Using a ratio >0.056 for EF, the sensitivity and specificity were 63% (95%CI 50-75%) and 100% (95%CI 63-100%) respectively. TLC/CRP ratio >0.056 is highly specific for EF. Prospective studies are warranted to confirm these findings.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3488-3488
Author(s):  
Jiri Pavlu ◽  
Rajvi Shah ◽  
Holger W. Auner ◽  
Dragana Milojkovic ◽  
David Marin ◽  
...  

Abstract Abstract 3488 It is important to determine prognostic indicators which may predict outcome of hematopoietic stem cell transplantation (HCT). The European Group for Blood and Marrow Transplantation (EBMT) proposed a scoring system for CML which, after modification, also predicted outcomes for patients transplanted for other hematologic malignancies. The HCT comorbidity index (HCT-CI) developed by Sorror et al. enabled further selection of patients for HCT based on their comorbidities. We have recently shown that the level of C-reactive protein (CRP) measured shortly before transplantation is another important prognostic factor in patients transplanted for CML in first chronic phase. In this study we tested the value of CRP together with other known prognostic factors in an independent cohort of 263 patients transplanted in a single institution from 1992 through 2009 for ALL (N=38, 14%) AML (N=72, 27%), MDS (N=19, 7%), and advanced phase CML (N=134, 51%). For the 130 (49%) recipients of stem cells from matched siblings conditioning consisted of cyclophosphamide and TBI. For the 133 (51%) unrelated donor transplant recipients in vivo T-cell depletion with anti CD52 antibody (Campath) was used in addition. Serum CRP levels were measured at a median of 16 days before stem cell infusion using a standard latex immunoassay (normal range 0–9 mg/L) while the patients were well without infection and off antibiotics. Patients' comorbidities were defined and assigned different weights (1-3) by the HCT-CI and disease stage was assessed in accordance with EBMT criteria. Thus, patients transplanted for AML (N=32) or ALL (N=27) in first complete remission were classified as early stage (N=59). Those with CML in accelerated phase (N=70), CML in second (N=42) or third (N=5) chronic phase, AML (N=19) or ALL (N=6) in second complete remission and MDS (N=19) were classified as intermediate stage (N=161). Patients with CML in blast phase (N=17) and acute leukemia in >2nd complete remission (N=26) or in relapse were defined as late stage (N=43). In univariate analysis, factors associated with day 100 nonrelapse mortality (NRM) were recipient's age at HCT, disease stage and preconditioning CRP level whereas disease stage, CRP level, and EBMT score were associated with overall survival (OS). In multivariate analysis only two factors showed independent prognostic value: late disease stage and elevated CRP level (>9 mg/L). Both predicted for inferior NRM (RR: 3.83, CI 1.65–8.92, P=.002 and RR: 1.51, CI 1.51–4.26, P<.001 respectively) and OS (RR: 2.88, CI 1.80–4.62, P< 0.001 and RR: 1.56, CI 1.15–2.13, P= 0.005). The day 100 NRM was 41% for patients with CRP>9 mg/L, 17% for those with CRP 0–9 mg/L (figure) and 25% for the whole cohort. The 5-year OS was 31.5% for patients with CRP 0–9 mg/L, 22.2% for those with CRP >9 mg/L and 28% for the whole cohort. There was no association between elevated preconditioning CRP levels and infection, either as a comorbidity or as a cause of death. The HCT-CI did not have a prognostic role in this cohort. These results confirm the high prognostic value of disease stage. Importantly, they extend our findings in early phase CML to other hematologic malignancies and establish pretransplantation levels of CRP as an independent predictor of allogeneic HCT outcomes. Disclosures: No relevant conflicts of interest to declare.


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