Résumé
Objective / background: A decision about the need for antimicrobial therapy in a patient with febrile neutropenia after hematopoietic stem cell transplantation [HSCT] is often complicated because of the low frequency of culture isolation and reduced clinical manifestation of infection. Usefulness and choice of sepsis biomarkers to distinguish bloodstream infection [BSI] from other causes of febrile episode is still argued in HSCT recipients in modern epidemiological situations characterized by the emergence of highly resistant gram-negative microorganisms. In this study a comparative analysis of diagnostic values of presepsin, procalcitonin [PCT], and C-reactive protein [CRP] was performed as sepsis biomarkers in adult patients after HSCT in a condition of high prevalence of gram-negative pathogens
Methods: A prospective observational clinical study was performed at the Center of Hematology and Bone Marrow Transplantation in Minsk, Republic of Belarus. The biomarkers [presepsin, PCT, and CRP] were assessed in a 4-hour period after the onset of febrile neutropenia episode in adult patients after HSCT. Microbiologically-confirmed BSI caused by a gram-negative pathogen was set as a primary outcome
Results: Clinical and laboratory data were analyzed in 52 neutropenic patients after HSCT aged 18-79 years. Out of the biomarkers assessed, the best diagnostic value was shown in presepsin [area under the curve [AUC]: 0.889, 95% confidence interval [CI]: 0.644-0.987, p < .0001] with 75% sensitivity and 100% specificity, then in PCT [AUC: 0.741, 95% CI: 0.573-0.869, p = .0037] with 62% sensitivity and 88% specificity. The optimal cut-off value for CRP was set as 165 mg/L, while it had an average diagnostic value [AUC: 0.707, 95% CI: 0.564-0.825, p = .0049] with low sensitivity [40%] and should not be routinely recommended as a biomarker in adult patients with suspected BSI after HSCT
Conclusion: Presepsin may be recommended in adult patients with suspected gram-negative BSI after HSCT as a possible additional supplementary test with a cut-off value of 218 pg/ mL. PCT is inferior to presepsin in terms of sensitivity and specificity, but still shows a good quality of diagnostic value with an optimal cut-off value of 1.5 ng/mL. CRP showed an average diagnostic value with low sensitivity [40%] and should not be routinely recommended as a biomarker in adult patients with suspected BSI after HSCT in a condition of high prevalence of gram-negative pathogens