Nilufer Eldes HACIFAZLIOGLU, Aynur OĞUZ, Ceyda KARADENİZ, Caglar Elvan CITAK

Prokalsitonin'in Çocukluk Çağı Nötropenik Ateşinde Tanısal Değeri

Amaç: Bu çalışmanın amacı çocukluk çağı nötropenik ateşinde prokalsitonin (PCT)'in bakteriyel ve sistemik enfesiyonların tanısı ve izlenmesindeki yararlılığının tespit edilmesidir.Gereç ve Yöntem: Bu çalışmada 32 kanser tanısı ile izlenen hastanın 46 nötropenik atağı değerlendirilmiştir. 35 yeni kanser tanısı alan olgu da kontrol grubu olarak seçilmiştir. Çalışma grubundaki olguların, ateşin 1. ve 3. günü ile antibiyotik tedavisinin sonunda; kontrol grubundaki olguların ise kanser tanısı aldıkları gün serum PCT ve CRP (C- reaktif protein) değerleri ölçülmüştür. Nötropenik ateş atakları; nedeni bilinmeyen ateş, mikrobiyolojik olarak kanıtlanmış enfeksiyon ve klinik olarak kanıtlanmış enfeksiyon olarak üç gruba ayrılmıştır. Mikrobiyolojik olarak kanıtlanmış infeksiyon grubu da; lokalize ve sistemik enfeksiyon olarak iki alt gruba ayrılmıştır.Bulgular: Mikrobiyolojik olarak kanıtlanmış enfeksiyon grubunda en yüksek serum PCT düzeyi enfeksiyonun ilk gününde tespit edilmiştir. Serum PCT düzeyleri; sistemik enfeksiyonu olan olgularda, lokalize enfeksiyonu olan olgulara göre daha yüksek tespit edilmiştir. Nedeni bilinmeyen ateş, klinik ve mikrobiyolojik olarak kanıtlanmış enfeksiyon, lokalize enfeksiyon ve sistemik enfeksiyon gruplarında; serum CRP düzeyleri açısından farklılık saptanmamıştır.Sonuç: Bu sonuçlar bize serum PCT düzeyinin bakteriyel ve sistemik infeksiyonun tanısı ve izleminde CRP'ye göre daha özgül ve duyarlı bir serum belirteci olduğunu düşündürmüştür.

Assessment of Procalcitonin as Diagnostic Marker in Children with Neutropenic Fever

Objective: The aim of this study is to predict the usefulness of procalcitonin (PCT) for diagnosis of systemic and bacterial infections in children with neutropenic fever.Material and Method: In this study 46 neutropenic fever attacks of the 32 cancer patients were evaluated. Newly diagnosed 35 cancer patients were selected as controls. Serum levels of PCT and CRP (C- reactive protein) were determined on the first and third days of fever and at the end of the antimicrobial therapy in study group. Neutropenic fever episodes were classified as fever of unknown origin (FUO), microbiologically and clinically documented infection (MDI, CDI). MDI were further subdivided into two groups as systemic and localized infection.Results: Serum levels of PCT were highest on the first day of neutropenic fever in MDI group. The levels of PCT were higher in systemic infections than localized ones. There was no difference for the serum levels of CRP in FUO, CDI and MDI or systemic and localized infections. The PCT levels rapidly decreased to the normal range by resolution of fever with successful antimicrobial therapy.Conclusion: We conclude that serial measurement of serum PCT levels is more sensitive and specific than that of CRP for diagnosis and sequential assessment of febrile neutropenic episodes.

PDF

___

1. White L, Ybarra M. Neutropenic fever. Emerg Med Clin North Am. 2014 Aug; 32(3):549-61.
2. Gozzard DI, French EA, Blecher TE, Powell JR. C-reactive protein levels in neutropenic patients with pyrexia. Cancer.1985; 7(4): 307-15.
3. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993; 341(8844): 515-8.
4. Bossink AW, Groeneveld AB, Thijs LG. Prediction of microbial infection and mortality in medical patients with fever: plasma procalcitonin; neutrophilic elestase, alpha 1-antityripsin, and lactoferrin compared with clinical variables. Clin Infect Dis. 1999; 29 (2): 398-407.
5. Delèvaux I, André M, Colombier M, Albuisson E, Meylheuc F, Bègue RJ, et al. Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes? Ann Rheum Dis. 2003; 62(4); 337-40.
6. Fleischhack G, Cipic D, Juettner J, Hasan C, Bode U Procalcitonin-a sensitive inflammation marker of febrile episodes in neutropenic children with cancer. Intensive Care Medicine. 2000;26:202-11
7. .Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, Galetto-Lacour A, et al. Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study. Arch Pediatr Adolesc Med. 2008;162(12):1157-63.
8. Hatherill M, Tibby SM, Sykes K, McIntyre AG, Murdoch IA. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child 1999; 81 (5): 417-21.
9. Meili M, Müller B, Kulkarni P, Schütz P. Management of patients with respiratory infections in primary care: procalcitonin, C-reactive protein or both? Expert Rev Respir Med. 2015; 9(5):587-601.
10. Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med 2000; 26(9)1193-200.
11. Milcent K, Faesch S, Gras-Le Guen C, Dubos F, Poulalhon C, Badier I, et al. Use of procalcitonin Assays to Predict Serious Bacterial Infection in Young Febrile Infants. JAMA Pediatr. 2015 23:1-8.
12. Gendrel D, Raymond J, Coste J, Moulin F, Lorrot M, Guérin S, et al. Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentiation of bacterial vs. viral infections. Pediatr Infect Dis J. 1999; 18: 875-81.
13. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004 Jul 15; 39(2):206- 17.
14. Sarmati L, Beltrame A, Dori L, Maffongelli G, Cudillo L, De Angelis G, et al. Procalcitonin is a reliable marker of severe systemic infection in neutropenic haematological patients with mucositis. Am J Hematol. 2010 May; 85(5):380-3.
15. 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. 2000; 111 (4): 1093-102.
16. Hatzistilianou M, Rekliti A, Athanassiadou F, Catriu D. Procalcitonin as an early marker of bacterial infection in neutropenic febrile children with acute lymphoblastic leukemia. Inflamm Res. 2010 May; 59(5):339-47.
17. Gencer S, Salepci T, Ozer S. Evaluation of infectious etiology and prognostic risk factors of febrile episodes in neutropenic cancer patients. J Infect. 2003; 47(1):65-72. 18. Engel A, Steinbach G, Kern P, Kern WV. Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis. 1999;31(2): 185-9.
19. Gac AC, Parienti JJ, Chantepie S, Fradin S, Le Coutour X, Leclercq R, et al.. Dynamics of procalcitonin and bacteremia in neutropenic adults with acute myeloid leukemia. Leuk Res. 2011;35(10):1294-6.
20. Wu CW, Wu JY, Chen CK, Huang SL, Hsu SC, Lee MT, et al. Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia? A systematic review and meta-analysis. Support Care Cancer. 2015;23(10):2863-72.
21. Giamarellou H, Giamarellos-Bourboulis EJ, Repoussis P, Galani L, Anagnostopoulos N, Grecka P, et al. Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study. Clin Microbiol Infect. 2004;10(7):628-33
22. Sakr Y, Burgett U, Nacul FE, Reinhart K,Brunkhorst F.The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection. 2008;36(5):396-407.
23. Prat C, Sancho JM, Dominguez J, Xicoy B, Gimenez M, Ferra C, et al. Evaluation of procalcitonin, neopterin, C-reactive protein, IL-6 and IL-8 as a diagnostic marker of infection in patients with febrile neutropenia. Leuk Lymphoma. 2008;49(9):1752-61.
24. Koivula I, Hämäläinen S, Jantunen E, Pulkki K, Kuittinen T, Nousiainen T, et al. Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia. Scand J Infect Dis. 2011;43(6- 7):471-8.