ATEŞLI NÖTROPENIK PEDIATRIK ONKOLOJI HASTALARINDA SCD14 ALT TIPININ SEPSIS BIYOBELIRTECI OLARAK TANIDAKI ROLÜ

Giriş ve Amaç: Bu çalışmada, Çocukluk çağında gelişen Febril Nötropeni FN hastalarında presepsin’in bakteriyemi/sepsisin saptanmasında ek bir tanı aracı olarak potansiyelini değerlendirmek amaçlanmıştır. Febril nötropeni kanser kemoterapisinin en yaygın komplikasyonlarından biridir ve acilen bir tedavi gerektirir. FN’ de kültür örnekleri alınmalı ve hızlı bir şekilde geniş spektrumlu antibiyoterapi uygulanmalıdır. Nötropenik hastalarda ateşin tek nedeni bakteriyel enfeksiyon değildir. Kemoterapötikler, hastalığın kendisi, viral ve fungal ajanlar ateşin diğer sebepleri olabilir. Ateş nedenini ayırt etmek için çeşitli biyolojik belirteçler araştırılmaktadır. Enfeksiyonlar nötropenik hastalarda çoğunlukla öldürücüdür, bu nedenle erken evredeki farklı biyobelirteçler bulunması son derece önemlidir.Yöntem: Toplam 29 febril nötropenik atak ve 24 pediatrik hasta çalışmaya alındı. Hastalar, bakteriemi/sepsis ve odağı olmayan ateş grubu olarak sınıflandırıldı. Serum örnekleri, FN teşhisi sonrasında toplandı ve presepsin, c-reaktif protein CRP ve prokalsitonin PCT konsantrasyonları analiz edildi.Bulgular: Bilinen biyolojik belirteçler, bakteriemi/sepsis ile odağı olmayan ateş grubu arasında ayırt edici bir değer göstermezken, presepin, hemokültürde bakteri gelişiminin bir göstergesi olarak anlamlı bulundu ve potansiyel bir tanısal değeri olduğu gösterildi.Sonuç: Presepsin, çocukluk çağı FN’li hastalarda bakteriyemi/sepsis tespiti için ilave bir tanı aracı olarak kullanılabilir

Diagnostic Role of Scd14-Subtype As a Sepsis Biomarker In Febrile Neutropenic Pediatric Oncology Patients

Introduction and Objective: Febrile neutropenia FN is one of the most common complications of cancer chemotherapy and requires urgent treatment. Upon diagnosis of childhood FN, culture samples should be obtained and a broad spectrum antibiotherapy should be administered immediately. However, bacterial infections are not the only cause of fever in neutropenic pediatric patients; chemotherapeutics, the disease itself, as well as viral and fungal agents can also be the cause of fever. Various biomarkers have been studied to differentiate the cause of fever to date. Infections are mostly lethal in neutropenic patients, early stage differential biomarkers are, therefore, of utmost importance. It is the aim of this study to assess the potential of presepsin as an additional diagnostic tool for the detection of bacteremia/sepsis in childhood Febrile Neutropenia FN patients. Methods: Twenty-four pediatric patients, with a total 29 febrile neutropenic episodes were enrolled in this study. One patient with 3 FN episodes, three patients with 2 FN episodes were admitted to our clinic during the study. Patients were classified into bacteremia/sepsis and fever without origin groups. Serum samples were collected after confirmation of FN and analyzed for presepsin, c-reactive protein CRP and procalcitonin PCT according to instructions of manufacturers. Results: Biomarkers failed to display a discriminative value between bacteremia/sepsis and fever without origin groups, whereas presepsin was found to be an indicator of the presence of bacterial growth in hemoculture and was shown to have a potential diagnostic value.Conclusion: Presepsin might be used as an additional diagnostic tool for the detection of bacteremia/sepsis in childhood FN patients

Keywords:

Biomarker Febrile Neutropenia, Presepsin, sCD14-subtype,

PDF

___

1. Fioredda F, Calvillo M, Bonanomi S, Coliva T, Tucci F, Farruggia P, et al. Congenital and acquired neutropenias consensus guidelines on therapy and follow-up in childhood from the Neutropenia Committee of the Marrow Failure Syndrome Group of the AIEOP (Associazione Italiana Emato-Oncologia Pediatrica). Am J Hematol 2012; 87: 238-43. [CrossRef]

2. Miedema KG, de Bont ES, Elferink RF, van Vliet MJ, Nijhuis CS, Kamps WA, et al. The diagnostic value of CRP, IL-8, PCT, and sTREM-1 in the detection of bacterial infections in pediatric oncology patients with febrile neutropenia. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2011;19:1593-600. [CrossRef]

3. Samraj RS, Zingarelli B, Wong HR. Role of biomarkers in sepsis care. Shock 2013; 40: 358-65. [CrossRef]

4. Karzai W, Oberhoffer M, Meier-Hellmann A, Reinhart K. Procalcitonin- -a new indicator of the systemic response to severe infections. Infection 1997; 25: 329-34.

5. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368-77. [CrossRef]

6. Bozza FA, Bozza PT, Castro Faria Neto HC. Beyond sepsis pathophysiology with cytokines: what is their value as biomarkers for disease severity? Mem Inst Oswaldo Cruz 2005; 100 Suppl 1: 217-21. [CrossRef]

7. Henriquez-Camacho C, Losa J. Biomarkers for sepsis. Biomed Res Int 2014; 2014: 547818. [CrossRef]

8. Secmeer G, Devrim I, Kara A, Ceyhan M, Cengiz B, Kutluk T, et al. Role of procalcitonin and CRP in differentiating a stable from a deteriorating clinical course in pediatric febrile neutropenia. Journal of pediatric hematology/oncology 2007; 29: 107-11. [CrossRef]

9. Urbonas V, Eidukaite A, Tamuliene I. The predictive value of soluble biomarkers (CD14 subtype, interleukin-2 receptor, human leucocyte antigen-G) and procalcitonin in the detection of bacteremia and sepsis in pediatric oncology patients with chemotherapy-induced febrile neutropenia. Cytokine 2013; 62: 34-7. [CrossRef]

10. Parnaby RM, Eaton SE, Shafi MS, Bell D. The value of serum C-reactive protein levels as a marker of sepsis in intensive care unit patients. Clinical intensive care : international journal of critical & coronary care medicine 1994; 5: 106-13.

11. Shozushima T, Takahashi G, Matsumoto N, Kojika M, Okamura Y, Endo S. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. Journal of infection and chemotherapy: official journal of the Japan Society of Chemotherapy 2011; 17: 764-9. [CrossRef]

12. Mussap M, Noto A, Fravega M, Fanos V. Soluble CD14 subtype presepsin (sCD14-ST) and lipopolysaccharide binding protein (LBP) in neonatal sepsis: new clinical and analytical perspectives for two old biomarkers. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet 2011; 24 Suppl 2: 12-4. [CrossRef ]

13. Okamura Y, Yokoi H. Development of a point-of-care assay system for measurement of presepsin (sCD14-ST). Clinica chimica acta; international journal of clinical chemistry 2011; 412: 2157-61. [CrossRef]

14. Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, et al. Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. Journal of infection and chemotherapy: official journal of the Japan Society of Chemotherapy 2012; 18: 891-7. [CrossRef]

15. Novelli G, Morabito V, Ferretti G, Pugliese F, Ruberto F, Venuta F, et al. Pathfast presepsin assay for early diagnosis of bacterial infections in surgical patients: preliminary study. Transplantation proceedings 2013; 45: 2750-3. [CrossRef]

16. Cakir Madenci O, Yakupoglu S, Benzonana N, Yucel N, Akbaba D, Orcun Kaptanagasi A. Evaluation of soluble CD14 subtype (presepsin) in burn sepsis. Burns: journal of the International Society for Burn Injuries 2014; 40: 664-9. [CrossRef]

17. Liu B, Chen YX, Yin Q, Zhao YZ, Li CS. Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department. Critical care 2013; 17: R244. [CrossRef]

18. Masson S, Caironi P, Spanuth E, Thomae R, Panigada M, Sangiorgi G, et al. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial. Critical care 2014; 18: R6. [CrossRef]

19. Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, et al. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clinica chimica acta; international journal of clinical chemistry 2011; 412: 1053-9. [CrossRef]

20. Spada S, Cuccu A, Mussap M, Testa M, Puddu M, Pisu C, et al. Reliability of procalcitonin in neonatology. Experience in 59 preterm newborns. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet 2009; 22 Suppl 3: 96-101. [CrossRef]

21. Hofer N, Zacharias E, Muller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology 2012; 102: 25-36. [CrossRef]

22. Magrini L, Gagliano G, Travaglino F, Vetrone F, Marino R, Cardelli P, et al. Comparison between white blood cell count, procalcitonin and C reactive protein as diagnostic and prognostic biomarkers of infection or sepsis in patients presenting to emergency department. Clinical chemistry and laboratory medicine: CCLM / FESCC 2014; 52: 1465-72. [CrossRef]

23. Yaegashi Y, Shirakawa K, Sato N, Suzuki Y, Kojika M, Imai S, et al. Evaluation of a newly identified soluble CD14 subtype as a marker for sepsis. Journal of infection and chemotherapy: official journal of the Japan Society of Chemotherapy 2005; 11: 234-8. [CrossRef]

24. Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. The Lancet Infectious diseases 2007; 7: 210-7. [CrossRef]