Metin DEMİRKAYA, Solmaz ÇELEBİ, Özlem ÖZDEMİR, Birol BAYTAN

Febril nötropenide C-reaktif protein ve prokalsitoninin yeri

Amaç: Febril nötropeni kanser hastalarında en önemli mortalite ve morbidite nedenidir. Bu nedenle tanının erken konması ve uygun antibiyoterapinin başlanması oldukça önemlidir. Bu çalışmada febril nötropenik hastalarda C-reaktif protein (CRP) ve prokalsitonin arasında sepsisin şiddeti ve tanımlanmasında bir farklılık olup olmadığını göstermek amaçlanmıştır.Gereç ve Yöntem: Bu prospektif çalışmaya Uludağ Üniversitesi Tıp Fakültesi Çocuk Hematoloji ve Onkoloji Ünitesinde febril nötropeni tanısıyla izlenen 30 olgu (35 atak) dahil edildi. Serum CRP ve prokalsitonin değerleri 0-5. günlerde alındı. Kültür üremesi, uzamış ateş, mukozitin varlığı ve mutlak nötrofil sayısı (MNS) ile karşılaştırma yapıldı. Bulgular: Akut lösemi tanısı alan 16 (%54) ve solid tümörlü olan 14 (%46) olgu incelendi. CRP ve prokalsitonin değerleri karşılaştırıldığında her iki parametrenin de pik değerine 1. günde ulaştığı ve benzer zamanlarda azaldığı görüldü, ancak aralarında istatistiksel olarak anlamlı korelasyon saptanmadı (r=0,2, p>0,05). Mukoziti ve kültür üremesi olan hastalarda parametreler açısından anlamlı bir fark yoktu. Ancak CRP, MNS

The value of C-reactive protein and procalcitonin in febrile neutropenia

Aim: Febrile neutropenia is the major cause of mortality and morbidity in cancer patients. For this reason, early diagnosis of severe infections and appropriate antimicrobial therapy are very important. The aim of this study was to investigate the difference between C-reactive protein (CRP) and procalcitonin in determining the sepsis and its severity. Materials and Method: A total of 30 children (35 episodes) with febrile neutropenia who were hospitalized in the Uludag University, Pediatric Hematology and Oncology Unit were included in this prospective study. The blood samples for CRP and procalcitonin were collected daily between 0 to 5th days. Serum CRP and procalcitonin levels were compared with culture positivity, prolonged fever, mucositis and absolute granulosit count (AGC). Results: A total of 16 patients (56%) diagnosed with acute leukemia and, 14 patients (46%) having solid tumours were evaluated. In sequential analysis of febrile episodes, both the median of procalcitonin and the CRP concentrations showed the same tendency and there was no significant correlation between them (r=0.2, p>0.05). There was no significant association between CRP and procalcitonin among those having positive culture and mucositis. However, CRP values at the 3rd, 4th and 5th days were significantly higher in the patients with AGC100/mm3. Similarly, CRP values were significantly higher at the 1st, 2nd, 3rd and 4th days among the patients having prolonged fever. Conclusion: Our study suggests that there is no difference between CRP and procalcitonin in determining sepsis and its severity. Although procalcitonin is a valuable acute phase reactant in non-neutropenic patients, larger prospective investigations are needed to show the prognostic value of procalcitonin in neutropenic patients.

PDF

___

1. Südhoff T, Giagounidis A, Karthaus M. Evaluation of neutropenic fever: value of serum and plasma parameters in clinical practice. Chemotherapy 2000;46:77-85.
2. Feld R. Multinational cooperation in trials and guidelines dealing with febrile neutropenia. Int J Antimicrob Agents 2000;16:185-7.
3. Fleischhack G, Kambeck I, Cipic D, Hasan C, Bode U. Procalcitonin in paediatric cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumour necrosis factor receptor II. Br J Haematol 2001;114:489-91.
4. Karin SR Massaro, Silvia F Costa, Claudio Leone et al. Procalcitonin (PCT) and C-reactive protein (CRP) as severe systemic infection markers in febrile neutropenic adults. BMC Infectious Diseases 2007;7:137-45.
5. Schuttrumpf S, Binder L, Hagemann T, Berkovic D, Trumper L, Binder C. Utility of procalcitonin concentration in the evaluation of patients with malignant diseases and elevated C-reactive protein plasma concentrations. Clin Infect Dis 2006:15;43:468-73.
6. Ruokonen E, Nousiainen T, Pulkki K, Takala J. Procalcitonin concentrations in patients with neutropenic fever. Eur J Clin Microbiol Infect Dis 1999;18:283-5.
7. Katz JA, Mustafa MM, Bash RO, Cash JV, Buchanan GR. Value of C-reactive protein determination in the initial diagnostic evaluation of the febrile, neutropenic child with cancer. Pediatr Infect Dis J 1992;11:708-12.
8. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997;16:735-46.
9. Becker KL, Neylen ES, Cohen R, Snider RH. Calcitonin: Structure, Molecular Biology, and Actions in Principles of Bone Biology. Acad Pres 1996;34:471-94.
10. 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.
11. Secmeer G, Devrim I, Kara A, Ceyhan M et al. Role of procalcitonin and CRP in differentiating a stable from a deteriorating clinical course in pediatric febrile neutropenia. J Pediatr Hematol Oncol 2007;29:107-11.
12. Küpeli S, Turul T, Cüzdancı C ve ark. Kemik iliği transplantasyonu yapılan çocuklarda prokalsitonin, kantitatif C-reaktif protein ve eritrosit sedimentasyon hızı değerleri. Çocuk Sağlığı ve Hastalıkları Dergisi 2007; 50:1-5.
13. Christofilopoulou S, Charvalos E, Petrikkos G. Could procalcitonin be a predictive biological marker in systemic fungal infections? Study of 14 cases. Eur J Intern Med 2002;13:493-5.
14. Ortega M, Rovira M, Filella X, Almela M et al. Prospective evaluation of procalcitonin in adults with febrile neutropenia after haematopoietic stem cell transplantation. Br J Haematol 2004;126:372-6.
15. Giamarellou H, Giamarellos-Bourboulis EJ, Repoussis P et al. Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study. Clin Microbiol Infect 2004;10:628-33.
16. Young B, Gleeson M, Cripps AW. C-reactive protein: a critical review. Pathology 1991;23:118-24.
17. Ciaccio M, Fugardi G, Titone L, Romano A et al. Procalcitonin levels in plasma in oncohaematologic patients with and without bacterial infections. Clin Chim Acta 2004;340:149-52.
18. Svaldi M, Hirber J, Lanthaler AI, Mayr O et al. Procalcitonin-reduced sensitivity and specificity in heavily leucopenic and immunosuppressed patients. Br J Haematol 2001;115:53-7.