Abstract
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.
Highlights
Patients receiving intensive chemotherapy for hematological malignancies frequently develop febrile neutropenia
All patients who were treated for acute myeloid leukemia (AML) or who were autologous stem cell transplant (ASCT) recipients receiving intensive chemotherapy were invited to participate in the study
Positive blood cultures were observed in 18 patients with febrile neutropenia (21%), and three of these patients (17%) developed septic shock
Summary
Patients receiving intensive chemotherapy for hematological malignancies frequently develop febrile neutropenia. They are at high risk of sepsis and septic complications. The onset of septic infection can be insidious, and the outcome may be fatal. An early diagnosis of sepsis is crucial in the prevention of serious complications, and it still remains a challenge for clinicians because of the lack of appropriate diagnostic methods [1]. C-reactive protein (CRP) is widely used as an indicator of infection, but it reacts too slowly for prognostic use at the early stages of sepsis [3]. Procalcitonin (PCT) has been studied in neutropenic patients and found to be useful in distinguishing sepsis from noninfectious causes of fever [4, 5]
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