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1.
Leuk Lymphoma ; 60(12): 3036-3043, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31122146

RESUMO

Commonly used indicators of sepsis are nonspecific and insufficient for predicting the course of febrile neutropenia (FN) in hematological patients. We analyzed data from 91 adult FN patients who received intensive chemotherapy for acute myeloid leukemia or autologous stem cell transplantation. Compared to patients with non-severe sepsis, patients with severe sepsis had significantly higher serum levels of tissue inhibitor of metalloproteinases-1 on the day of first occurrence of fever (day 0: 172 vs. 112 µg/L, p= .002) and for the two following days (day 1: 219 vs. 128 µg/L, p< .001; day 2: 443 vs. 128 µg/L, p= .001), and significantly higher serum levels of matrix metalloproteinase-10 on day 1 (1975 vs. 876 ng/L, p= .001) and day 2 (2020 vs. 841 ng/L, p< .001). We conclude that the measurement of these biomarkers may be useful in predicting the severity of sepsis in FN patients.

2.
Eur J Haematol ; 2018 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-30099772

RESUMO

OBJECTIVE: The study aim was to compare the performance of interleukin-1 receptor antagonist (IL-1Ra) to C-reactive protein (CRP) and procalcitonin (PCT) in early prediction of the clinical course of febrile neutropenia. METHODS: The study population consisted of 86 consecutive patients with febrile neutropenia who received intensive chemotherapy for haematological malignancy between November 2009 and November 2012 at the adult haematology ward of Kuopio University Hospital. Twenty-three (27%) patients had acute myeloid leukaemia and 63 (73%) patients were autologous stem cell transplant recipients. IL-1Ra, CRP and procalcitonin were measured at the onset of fever (d0), on day 1 (d1) and on day 2 (d2). RESULTS: Eight patients developed severe sepsis, including three patients with septic shock. Eighteen patients had bacteraemia. After the onset of febrile neutropenia Youden´s indices (with their 95% confidence intervals) to identify severe sepsis were for IL-1Ra on d0 0.57 (0.20-0.71) and on d1 0.65 (0.28-0.78), for CRP on d0 0.41 (0.04-0.61) and on d1 0.47 (0.11-0.67) and for PCT on d0 0.39 (0.05-0.66) and on d1 0.52 (0.18-0.76). CONCLUSIONS: In haematological patients, IL-1Ra has a comparable capacity with CRP and PCT to predict severe sepsis at the early stages of febrile neutropenia.

3.
Dis Markers ; 2018: 6964529, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29849825

RESUMO

Background: Novel potential small molecular biomarkers for sepsis were analyzed with nontargeted metabolite profiling to find biomarkers for febrile neutropenia after intensive chemotherapy for hematological malignancies. Methods: Altogether, 85 patients were included into this prospective study at the start of febrile neutropenia after intensive chemotherapy for acute myeloid leukemia or after autologous stem cell transplantation. The plasma samples for the nontargeted metabolite profiling analysis by liquid chromatography-mass spectrometry were taken when fever rose over 38° and on the next morning. Results: Altogether, 90 differential molecular features were shown to explain the differences between patients with complicated (bacteremia, severe sepsis, or fatal outcome) and noncomplicated courses of febrile neutropenia. The most differential compounds were an androgen hormone, citrulline, and phosphatidylethanolamine PE(18:0/20:4). The clinical relevance of the findings was evaluated by comparing them with conventional biomarkers like C-reactive protein and procalcitonin. Conclusion: These results hold promise to find out novel biomarkers for febrile neutropenia, including citrulline. Furthermore, androgen metabolism merits further studies.


Assuntos
Neutropenia Febril/sangue , Leucemia/complicações , Metaboloma , Adolescente , Adulto , Idoso , Androgênios/sangue , Biomarcadores/sangue , Citrulina/sangue , Neutropenia Febril/etiologia , Feminino , Humanos , Leucemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Fosfatidiletanolaminas/sangue
5.
Infect Dis (Lond) ; 50(6): 436-442, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29303041

RESUMO

BACKGROUND: The aim of the study was to explore the incidence, microbiological etiology and outcome of febrile neutropenia among adult hematological patients following autologous stem cell transplantation (ASCT). METHODS: The study population consisted of patients who received ASCT between 1 December 2006 and 30 November 2012. The epidemiology was compared to a retrospective series covering eleven previous years at the same institution. Non-Hodgkin lymphoma (NHL) patients, who had been identified as a risk group in the retrospective study, received ciprofloxacin prophylaxis from January 2008. RESULTS: Altogether, 142 out of 178 of the included patients (80%) developed febrile neutropenia. The blood cultures were positive in 24 cases (17%). Of all bacteremia's, 88% were caused by Gram-positive and 12% by Gram-negative bacteria. The number of Gram-negative bacteremia were significantly lower in the prospective study compared to the retrospective study (3/142, 2.1% vs. 23/265, 8.7%, p = .01). Pseudomonas aeruginosa was prevalent in the retrospective series but not discovered in the present series. Enterococcus faecium was found more frequently in the prospective study (6/142, 4.2 vs. 2/265, 0.8%, p = .02). The infectious mortality among patients with febrile neutropenia was 4/142 (2.8%) in the present series and 9/265 (3.4%) in those who received ASCT in 1996-2006. CONCLUSION: Most patients who received ASCT developed febrile neutropenia and a minority had bacteraemia. In comparison to the earlier time period, the incidence of Gram-negative bacteraemias decreased, probably due to ciprofloxacin prophylaxis in NHL patients, but simultaneously the incidence of Enterococcus bacteraemias increased. Infectious mortality during febrile neutropenia was low in both series.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Neutropenia Febril/tratamento farmacológico , Neutropenia Febril/microbiologia , Transplante de Células-Tronco Hematopoéticas , Adolescente , Adulto , Idoso , Bacteriemia/epidemiologia , Bacteriemia/mortalidade , Neutropenia Febril/epidemiologia , Neutropenia Febril/mortalidade , Feminino , Finlândia/epidemiologia , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Dis Markers ; 2017: 9805609, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28845081

RESUMO

OBJECTIVE: Elevated levels of a cell surface glycoprotein, soluble cluster of differentiation 14 (sCD14), have been observed in patients with sepsis. Only scarce data are available on sCD14 in hematological patients with chemotherapy-induced febrile neutropenia. The study aim was to investigate sCD14 as an early biomarker in febrile neutropenia after intensive chemotherapy to detect a rapidly deteriorating clinical course early enough to avoid serious infectious complications. PATIENTS AND METHODS: This prospective study included 87 adult hematological patients at the start of febrile neutropenia after intensive chemotherapy for acute myeloid leukemia or after autologous stem cell transplantation. The study endpoints were septic shock, severe sepsis, and positive blood culture findings. sCD14 was analyzed from day 0 to day 2, and its prognostic capacity was compared to that of C-reactive protein and procalcitonin. RESULTS: Plasma level of sCD14 predicted the development of septic shock on day 1 (p = 0.001) and day 2 but not the development of severe sepsis or blood culture positivity in hematological patients with chemotherapy-induced febrile neutropenia. CONCLUSIONS: Soluble CD14 did not predict an overall complicated course at the early stages of febrile neutropenia. However, it was helpful in predicting the progression of the clinical course of neutropenic fever to septic shock.


Assuntos
Neutropenia Febril/sangue , Leucemia Mieloide/tratamento farmacológico , Receptores de Lipopolissacarídeos/sangue , Choque Séptico/sangue , Adolescente , Adulto , Idoso , Antineoplásicos/efeitos adversos , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Calcitonina/sangue , Estudos de Casos e Controles , Neutropenia Febril/etiologia , Feminino , Humanos , Leucemia Mieloide/cirurgia , Masculino , Pessoa de Meia-Idade , Choque Séptico/etiologia , Transplante de Células-Tronco/efeitos adversos
8.
Scand J Clin Lab Invest ; 77(2): 130-134, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28218011

RESUMO

Asymmetric dimethylarginine (ADMA) has been recognized as an independent prognostic factor for sepsis mortality in intensive care units. No data are available on kinetics or prognostic value of ADMA in hematological patients. We evaluated the ability of ADMA to act as a predictor for complicated course of febrile neutropenia, defined as bacteremia and/or septic shock in adult hematological patients receiving intensive chemotherapy. This prospective study included 87 adult hematological patients with febrile neutropenia after an intensive chemotherapy for acute myeloid leukemia (AML) or after an autologous stem cell transplantation (ASCT). Plasma ADMA and serum C-reactive protein (CRP) levels were measured from the onset of fever (d0) and for 2 days (d1-d2) thereafter. The levels of ADMA were stable or had only minimal changes during the study period. There was no difference between the levels at any time-point in patients having complicated course compared to those without it. On the other hand, CRP levels were significantly higher on d1 (p = 0.016) in patients with bacteremia and/or septic shock than in those without. ADMA was not able to differentiate hematological patients with a complicated course from those without complications. Elevated ADMA levels are probably associated with organ dysfunction, which is rare in this group of patients, of whom about 95% can be successfully managed at the hematology ward.


Assuntos
Arginina/análogos & derivados , Bacteriemia/diagnóstico , Proteína C-Reativa/metabolismo , Neutropenia Febril/diagnóstico , Choque Séptico/diagnóstico , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Arginina/sangue , Bacteriemia/complicações , Bacteriemia/microbiologia , Bacteriemia/terapia , Biomarcadores/sangue , Neutropenia Febril/complicações , Neutropenia Febril/microbiologia , Neutropenia Febril/terapia , Feminino , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/microbiologia , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Choque Séptico/complicações , Choque Séptico/microbiologia , Choque Séptico/terapia , Transplante de Células-Tronco , Transplante Autólogo
9.
Eur J Hum Genet ; 24(10): 1473-8, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27142677

RESUMO

Antibody class-switch recombination and somatic hypermutation critically depend on the function of activation-induced cytidine deaminase (AID). Rare variants in its gene AICDA have been reported to cause autosomal recessive AID deficiency (autosomal recessive hyper-IgM syndrome type 2 (HIGM2)). Exome sequencing of a multicase Finnish family with an HIGM2 phenotype identified a rare, homozygous, variant (c.416T>C, p.(Met139Thr)) in the AICDA gene, found to be significantly enriched in the Finnish population compared with other populations of European origin (38.56-fold, P<0.001). The population history of Finland, characterized by a restricted number of founders, isolation and several population bottlenecks, has caused enrichment of certain rare disease-causing variants and losses of others, as part of a phenomenon called the Finnish Disease Heritage. Accordingly, rare founder mutations cause the majority of observed Finnish cases in these mostly autosomal recessive disorders that consequently are more frequent in Finland than elsewhere. Screening of all currently known Finnish patients with an HIGM2 phenotype showed them to be homozygous for p.(Met139Thr). All the Finnish p.(Met139Thr) carriers with available data on their geographic descent originated from the eastern and northeastern parts of Finland. They were observed to share more of their genome identity by descent (IBD) than Finns in general (P<0.001), and they all carried a 207.5-kb ancestral haplotype containing the variant. In conclusion, the identified p.(Met139Thr) variant is significantly enriched in Finns and explains all thus far found AID deficiencies in Finland.


Assuntos
Citidina Desaminase/genética , Frequência do Gene , Síndrome de Imunodeficiência com Hiper-IgM/genética , Mutação , Linhagem , Adulto , Criança , Feminino , Finlândia , Efeito Fundador , Haplótipos , Heterozigoto , Homozigoto , Humanos , Síndrome de Imunodeficiência com Hiper-IgM/diagnóstico , Lactente , Masculino
10.
Duodecim ; 132(21): 1946-51, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29190045

RESUMO

Neutropenic sepsis is a common clinical problem in hematological patients receiving intensive chemotherapy. Complications will develop in a minority of these patients. Biomarkers can be used for the recognition of infection as well as to estimate its severity and risk of complications and also to assess treatment response. Experience gained from other patient groups or sepsis patients treated in intensive care units cannot be directly extrapolated to hematological patients. Numerous biomarkers of infections have been investigated in hematological patients, but no optimal marker has been found. C-reactive protein is still the most commonly used biomarker in hematological patients, but procalcitonin may be a real challenger, although more studies are still needed.


Assuntos
Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Calcitonina/sangue , Neutropenia/sangue , Sepse/sangue , Humanos , Unidades de Terapia Intensiva
11.
Euro Surveill ; 20(42)2015.
Artigo em Inglês | MEDLINE | ID: mdl-26538367

RESUMO

We report a case of pulmonary cystic echinococcosis in a child from eastern Finland with no history of travelling abroad. The cyst was surgically removed and the organism molecularly identified as Echinococcus canadensis genotype G10. This parasite is maintained in eastern Finland in a sylvatic life cycle involving wolves and moose; in the present case, the infection was presumably transmitted by hunting dogs.


Assuntos
Cães/parasitologia , Equinococose Pulmonar/diagnóstico , Echinococcus/genética , Animais , Criança , Equinococose Pulmonar/parasitologia , Equinococose Pulmonar/cirurgia , Echinococcus/isolamento & purificação , Finlândia , Genótipo , Humanos , Masculino , Derrame Pleural , Radiografia Torácica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
12.
Infect Dis (Lond) ; 47(4): 255-9, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25664374

RESUMO

Neutropenic fever is common in patients receiving intensive chemotherapy for hematological malignancies. The clinical course may be aggravated by infectious complications like severe sepsis, septic shock or even death. We prospectively studied 100 patients with neutropenic fever and evaluated human plasma cell-free DNA (cfDNA) during the first 3 days after the onset of fever as a prognostic biomarker for complicated clinical course, defined as sepsis or septic shock. Complicated course was observed in 21 patients (21%). There were no significant differences in cfDNA levels between the patients with or without complications on any study day when all the patients were analyzed as one group. In subgroups according to hematological malignancy, patients with acute myeloid leukemia (AML) had lower cfDNA levels than patients with lymphoma. Among AML patients d0 cfDNA/leukocyte ratio and among lymphoma patients d0 cfDNA was associated with subsequent development of sepsis or septic shock. cfDNA deserves further studies in hematological patients with sepsis.


Assuntos
Neutropenia Febril Induzida por Quimioterapia/complicações , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , DNA/sangue , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/epidemiologia , Sepse , Adolescente , Adulto , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Biomarcadores/sangue , Feminino , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/sangue , Sepse/complicações , Sepse/epidemiologia , Adulto Jovem
13.
Blood ; 123(6): 863-74, 2014 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-24345756

RESUMO

Constitutive heterozygous GATA2 mutation is associated with deafness, lymphedema, mononuclear cytopenias, infection, myelodysplasia (MDS), and acute myeloid leukemia. In this study, we describe a cross-sectional analysis of 24 patients and 6 relatives with 14 different frameshift or substitution mutations of GATA2. A pattern of dendritic cell, monocyte, B, and natural killer (NK) lymphoid deficiency (DCML deficiency) with elevated Fms-like tyrosine kinase 3 ligand (Flt3L) was observed in all 20 patients phenotyped, including patients with Emberger syndrome, monocytopenia with Mycobacterium avium complex (MonoMAC), and MDS. Four unaffected relatives had a normal phenotype indicating that cellular deficiency may evolve over time or is incompletely penetrant, while 2 developed subclinical cytopenias or elevated Flt3L. Patients with GATA2 mutation maintained higher hemoglobin, neutrophils, and platelets and were younger than controls with acquired MDS and wild-type GATA2. Frameshift mutations were associated with earlier age of clinical presentation than substitution mutations. Elevated Flt3L, loss of bone marrow progenitors, and clonal myelopoiesis were early signs of disease evolution. Clinical progression was associated with increasingly elevated Flt3L, depletion of transitional B cells, CD56(bright) NK cells, naïve T cells, and accumulation of terminally differentiated NK and CD8(+) memory T cells. These studies provide a framework for clinical and laboratory monitoring of patients with GATA2 mutation and may inform therapeutic decision-making.


Assuntos
Linfócitos B/patologia , Células Dendríticas/patologia , Fator de Transcrição GATA2/genética , Células Matadoras Naturais/patologia , Monócitos/patologia , Mutação/genética , Síndromes Mielodisplásicas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Linfócitos B/imunologia , Linfócitos B/metabolismo , Biomarcadores , Estudos de Casos e Controles , Criança , Pré-Escolar , Evolução Clonal , Estudos Transversais , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Estudos de Associação Genética , Humanos , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/metabolismo , Masculino , Pessoa de Meia-Idade , Monócitos/imunologia , Monócitos/metabolismo , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/genética , Linhagem , Prognóstico , Adulto Jovem , Tirosina Quinase 3 Semelhante a fms/metabolismo
15.
Duodecim ; 128(21): 2272-6, 2012.
Artigo em Finlandês | MEDLINE | ID: mdl-23210290

RESUMO

Mycoplasma pneumoniae causes up to 10-40 % of community-acquired pneumonias. The incidence of M. pneumoniae pneumonia is greatest among children and young adults. The symptoms of M. pneumoniae upper and lower respiratory infections are usually mild and often self-limited. The most frequent extrapulmonary complications present in CNS, heart and skin. The skin affiliations are usually transient erythematous maculopapular or vesicular rashes but may sometimes evolve into Stevens-Johnson syndrome. M. pneumoniae is one of the most common microbe behind the infectious causes of SJS. We present a patient who developed incomplete Stevens-Johnson syndrome concomitant of Mycoplasma pneumoniae pneumonia.


Assuntos
Infecções Comunitárias Adquiridas/complicações , Pneumonia por Mycoplasma/complicações , Síndrome de Stevens-Johnson/microbiologia , Humanos
16.
Cytokine ; 60(3): 787-92, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22902948

RESUMO

Early diagnosis of complicated course in febrile neutropenia is cumbersome due to the non-specificity of clinical and laboratory signs of severe infection. This prospective study included 100 adult hematological patients with febrile neutropenia after intensive chemotherapy at the onset of fever (d0) and for 3 days (d1-d3) thereafter. The study aim was to find early predictors for complicated course of febrile neutropenia, defined as bacteremia or septic shock. Interleukin 6 (IL-6), interleukin 10 (IL-10), procalcitonin (PCT) and C-reactive protein (CRP) all predicted complicated course of febrile neutropenia on d0, but only PCT was predictive throughout the study period. For IL-10 on d0-1 with cut-off 37 ng/L, sensitivity was 0.71, specificity 0.82, positive predictive value 0.52 and negative predictive value 0.92. For PCT on d0-1 with cut-off 0.13 µg/L, the respective measures were 0.95, 0.53, 0.36, and 0.98. For the combination of IL-10 and PCT on d0-1 with the same cut-offs, specificity improved to 0.85 and positive predictive value to 0.56. In conclusion, the present study confirms the high negative predictive value of PCT and provides new evidence for IL-10 as an early predictor for complicated course of febrile neutropenia in hematological patients. Combining IL-10 with PCT improves the early prediction for complicated course of febrile neutropenia.


Assuntos
Bacteriemia/diagnóstico , Calcitonina/sangue , Interleucina-10/sangue , Neutropenia/complicações , Precursores de Proteínas/sangue , Choque Séptico/diagnóstico , Adolescente , Adulto , Idoso , Proteína C-Reativa/análise , Calcitonina/metabolismo , Peptídeo Relacionado com Gene de Calcitonina , Feminino , Febre/etiologia , Humanos , Interleucina-10/metabolismo , Interleucina-6/sangue , Interleucina-6/metabolismo , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Neutropenia/diagnóstico , Prognóstico , Estudos Prospectivos , Precursores de Proteínas/metabolismo , Transplante de Células-Tronco , Transplante Autólogo , Adulto Jovem
17.
Peptides ; 36(1): 129-32, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22580173

RESUMO

Copeptin, the surrogate marker of arginine vasopressin (AVP), has been suggested to be a useful biomarker in monitoring sepsis reflecting hemodynamic imbalance and stress state. This prospective study conducted at a hematology ward in a Finnish University Hospital aimed to investigate whether plasma copeptin predicts the development of complicated course of neutropenic fever (bacteremia or need for treatment at intensive care unit) in 100 hematological patients experiencing their first neutropenic fever episode after intensive chemotherapy for hematological malignancy. Contrary to study presumptions, not elevated copeptin but the lack of a proper initial increase of plasma copeptin (<0.02 ng/mL from day 0 to day 1) predicted blood culture positive sepsis (p=0.023) and gram-negative bacteremia (p=0.045). No correlation was observed with plasma sodium, blood pressure or evaluated osmolality. Plasma copeptin correlated inversely with the same day pentraxin 3 on day 0-day 2 (all p-values <0.001) and with C-reactive protein on day 1 (p=0.015). In conclusion, copeptin did not correlate with disease severity, but the lack of a proper initial increase was associated with bacteremic complications of febrile neutropenia in hematological patients. The findings suggest the possibility of central dysregulation of AVP release and do not support the use of copeptin as a biomarker of septic complications in this patient group.


Assuntos
Bacteriemia/sangue , Febre/sangue , Glicopeptídeos/sangue , Neutropenia/sangue , Adolescente , Adulto , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Bacteriemia/etiologia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Feminino , Febre/etiologia , Humanos , Hidrocortisona/sangue , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neutropenia/etiologia , Estudos Prospectivos , Componente Amiloide P Sérico/metabolismo , Adulto Jovem
18.
Haematologica ; 96(9): 1385-9, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21880642

RESUMO

We evaluated pentraxin 3 as a marker for complications of neutropenic fever in 100 hematologic patients receiving intensive chemotherapy. Pentraxin 3 and C-reactive protein were measured at fever onset and then daily to day 3. Bacteremia was observed in 19 patients and septic shock in 5 patients (three deaths). In comparison to C-reactive protein, pentraxin 3 achieved its maximum more rapidly. Pentraxin 3 correlated not only with the same day C-reactive protein but also with the next day C-reactive protein. High pentraxin 3 on day 0 was associated with the development of septic shock (P=0.009) and bacteremia (P=0.046). The non-survivors had constantly high pentraxin 3 levels. To conclude, pentraxin 3 is an early predictor of complications in hematologic patients with neutropenic fever. High level of pentraxin 3 predicts septic shock and bacteremia already at the onset of febrile neutropenia. (ClinicalTrials.gov Identifier: NCT00781040.).


Assuntos
Antineoplásicos/efeitos adversos , Bacteriemia/diagnóstico , Proteína C-Reativa/metabolismo , Neutropenia/complicações , Componente Amiloide P Sérico/metabolismo , Choque Séptico/diagnóstico , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Bacteriemia/etiologia , Biomarcadores/metabolismo , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Prognóstico , Choque Séptico/etiologia , Transplante Autólogo , Adulto Jovem
19.
Leuk Lymphoma ; 52(12): 2349-55, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21756036

RESUMO

We compared biomarkers and their changes as predictors for bacteremia and severe sepsis during neutropenic fever after intensive chemotherapy in hematological patients. Serum C-reactive protein (CRP), semi-quantative procalcitonin, aminoterminal pro-brain natriuretic peptide (NT-proBNP), cortisol, lactate, plasma antithrombin and fibrinogen were measured daily from day 0 to day 3/day 4 in 89 neutropenic fever episodes of 65 hematological patients. The best predictors for bacteremia and gram-negative bacteremia were procalcitonin and its change, with odds ratios (ORs) and 95% confidence intervals of 2.63 (1.56-4.44) and 3.20 (1.77-5.80) for bacteremia and 4.14 (2.00-8.58) and 5.04 (2.18-11.63) for gram-negative bacteremia, respectively. For severe sepsis, the best predictors were CRP and fibrinogen, with ORs of 1.94 (1.07-3.52) and 1.92 (1.05-3.54). Factor analysis provided two predictive factors: procalcitonin-NT-proBNP-antithrombin factor predicted gram-negative bacteremia and CRP-fibrinogen predicted severe sepsis. Applying a combination of markers reflecting different aspects of infection might improve the recognition of risk for complications in patients with neutropenic fever.


Assuntos
Bacteriemia/diagnóstico , Biomarcadores/sangue , Febre/etiologia , Neoplasias Hematológicas/complicações , Neutropenia/complicações , Sepse/diagnóstico , Adolescente , Adulto , Idoso , Bacteriemia/complicações , Análise Fatorial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Sepse/complicações , Adulto Jovem
20.
Eur J Haematol ; 87(5): 441-7, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21676033

RESUMO

OBJECTIVES: This study aimed at assessing the cut-off levels for pentraxin 3 (PTX3) in predicting complications of neutropenic fever (bacteraemia, septic shock) in haematological patients. METHODS: A prospective study during 2006-2009 was performed at haematology ward in Kuopio University Hospital. A patient was eligible for the study if having neutropenic fever after intensive therapy for acute myeloid leukaemia (AML) (n = 32) or non-Hodgkin lymphoma (NHL) (n = 35). Blood cultures were taken, and maximal PTX3 and C-reactive protein (CRP) were evaluated during d0 to d3 from the beginning of fever onset. RESULTS: The level of PTX3 was associated with both the underlying malignancy and the presence of complications, with highest level in NHL patients with complicated course of febrile neutropenia and lowest in AML patients with non-complicated course. The cut-off level of PTX3 to predict complications was ten-fold in patients with NHL (115 µg/L) in comparison with patients with AML (11.5 µg/L). In combined analysis based on separate cut-offs, PTX3 predicted complications of febrile neutropenia with sensitivity of 0.86, specificity of 0.83, positive predictive value of 0.57 and negative predictive value of 0.96. CONCLUSIONS: PTX3 was superior to CRP in predicting complicated course of febrile neutropenia, but only when the effect of the underlying malignancy had been taken into account.


Assuntos
Proteína C-Reativa/fisiologia , Febre/patologia , Neoplasias Hematológicas/patologia , Neutropenia/patologia , Componente Amiloide P Sérico/fisiologia , Adolescente , Adulto , Idoso , Feminino , Febre/complicações , Febre/microbiologia , Neoplasias Hematológicas/classificação , Neoplasias Hematológicas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/complicações , Estudos Prospectivos , Adulto Jovem
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