Presepsin may help detect febrile neutropaenia during chemotherapy
Plasma presepsin appears to be an effective diagnostic marker for febrile neutropaenia (FN) in patients on massive chemotherapy, according to a Japanese study.
Derived from the cluster of differentiation 14 (CD14) protein, presepsin has been used for the prognosis and early diagnosis of severe sepsis. “While this molecule is a prompt and specific marker for bacterial infections, its reliability in FN is not yet confirmed,” said researchers, adding that the severe neutropaenia observed during massive chemotherapy may cause false-negative results for this marker.
To determine whether presepsin levels increase with bacteraemia in the setting of severe neutropaenia, researchers included patients with haematologic malignancy or bone marrow failure who developed severe neutropaenia after undergoing either conventional induction chemotherapy or haematopoietic stem cell transplantation (HSCT).
Patients were divided into two groups: those who were diagnosed with bacteraemia during a period of neutropaenia (FN group) and a control group consisting of patients with who had no febrile episodes for 3 weeks after chemotherapy but did not receive antimicrobial treatment (afebrile neutropaenia [AFN] group). A neutropaenic period was defined as a white blood cell (WBC) count <1,000/μL or neutrophil count <500/μL.
Plasma presepsin levels of FN patients were measured every 2 to 3 days and values compared with those of the AFN group. Outcome measures included presepsin levels at baseline and at FN onset, presepsin increase rate at FN onset, and onset/baseline ratio.
Eleven episodes of FN (with six gram-negative and five gram-positive pathogens identified in blood cultures) were reported and analysed in detail. Plasma presepsin levels were strongly associated with CRP levels (r=0.61; p<0.01), but not with the absolute WBC count (r=−0.19; p=0.19), absolute neutrophil count (r=−0.11; p=0.41) or absolute monocyte count (r=−0.12; p=0.40).
The presepsin cutoff value, which was set at 314 pg/mL, detected FN onset in nine of 11 cases, with the two undetected cases caused by Bacillus species.
On evaluating for renal function, researchers found no association between plasma presepsin levels and serum creatinine (r=0.08, p=0.55) or estimated glomerular filtration rate (r=0.21, p=0.12).
Although FN is a common infectious complication in chemotherapy, patients with haematologic malignancies who develop FN carry a higher risk of mortality.In light of study findings, researchers posited that plasma presepsin may be a reliable marker of FN even in this population who has very low WBC counts. Closer monitoring of presepsin levels may be of benefit in the early diagnosis of FN, said researchers.