Abstract
Objective:The significance of mannose-binding lectin (MBL) and H-ficolin deficiency in febrile neutropenic (FN) patients and the correlation of these markers along with consecutive C-reactive protein (CRP) and procalcitonin (PCT) levels during the infectious process are investigated.Materials and Methods:Patients with any hematological malignancies who were defined to have “microbiologically confirmed infection”, “clinically documented infection”, or “fever of unknown origin” were included in this single-center prospective observational study. Serum levels of CRP, PCT, MBL, and H-ficolin were determined on 3 separate occasions: at baseline (between hospital admission and chemotherapy), at the onset of fever, and at the 72nd hour of fever.Results:Forty-six patients (54% male, mean age 41.7 years) with 61 separate episodes of FN were evaluated. Eleven patients (23.9%) had “microbiologically confirmed infection”, 17 (37%) had “clinically documented infection”, and 18 (39.1%) had “fever of unknown origin”. Fourteen (30.4%) patients had low (<500 ng/mL) initial MBL levels and 7 (15.21%) had low (<12,000 ng/mL) H-ficolin levels. Baseline MBL and H-ficolin levels did not significantly change on the first and third days of fever (p=0.076). Gram-negative bacteremia more frequently occurred in those with low initial MBL levels (p=0.006). PCT levels were significantly higher in those with microbiologically documented infections. Mean and median PCT levels were significantly higher in cases with bacteremia. There was no significant difference between hemoculture-positive and-negative patients in terms of CRP levels.Conclusion:Monitoring serum H-ficolin levels was shown to be of no benefit in terms of predicting severe infection. Low baseline MBL levels were correlated with high risk of gram-negative bacteremia; however, no significant correlation was shown in the follow-up. Close monitoring of PCT levels is warranted to provide more accurate and specific data while monitoring cases of bacteremia.
Highlights
Blood stream infections (BSIs) due to invasive bacterial and fungal pathogens are major causes of infection related mortality
Monitoring serum H-ficolin levels was shown to be of no benefit in terms of predicting severe infection
Low baseline mannose-binding lectin (MBL) levels were correlated with high risk of gram-negative bacteremia; no significant correlation was shown in the follow-up
Summary
Blood stream infections (BSIs) due to invasive bacterial and fungal pathogens are major causes of infection related mortality. Gram-negative and gram-positive bacteremia account for 50%-60% of BSIs during febrile neutropenia (FN) episodes [1,2,3]. Hemoculture is still the standard diagnostic method, but the positivity rate is only about 20-50% in FN episodes [4] and microbial identification takes 2-6 days [1]. Antibacterial therapy is initiated immediately after blood cultures are obtained and before any other diagnostic procedures, in accordance with guidelines. Leukocytes and differential blood count, hemoglobin, platelets, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, lactate dehydrogenase, alkaline phosphatase, gamma glutamyltransferase, bilirubin, uric acid, creatinine, sodium, potassium, partial thromboplastin time, and C-reactive protein (CRP) are measured twice a week before and during therapy in the routine practice of our hematology section.
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