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Observational Study
. 2019 Jun;24(4):401-406.
doi: 10.1080/1354750X.2019.1600023. Epub 2019 Apr 4.

Combination of sepsis biomarkers may indicate an invasive fungal infection in haematological patients

Affiliations
Observational Study

Combination of sepsis biomarkers may indicate an invasive fungal infection in haematological patients

Igor Stoma et al. Biomarkers. 2019 Jun.

Abstract

Background: Invasive fungal infections are a major threat to a large cohort of immunocompromised patients, including patients with chemotherapy-associated neutropenia. Early differential diagnosis with bacterial infections is often complicated, which leads to a delay in empirical antifungal therapy and increases risk for adverse outcome. Accessibility and performance of specific fungal antigen and PCR-tests are still limited, while sepsis biomarkers are more broadly used in most settings currently. Methods: Haematological patients hospitalized to receive chemotherapy with proven or probable invasive fungal infection or microbiologically proven bacterial bloodstream infection were included in the study. C-reactive protein was assessed daily during the profound neutropenia period, while procalcitonin or presepsin were measured during the first 48 hours after the onset of febrile episode. Results: There were totally 64 patients included in the study, 53 with bacterial bloodstream infections and 11 with invasive fungal infections. Combination of CRP >120 with PCT <1.25 or presepsin <170 was shown to be a possible combined biomarker for invasive fungal infections in immunocompromised patients, with areas under the ROC-curves: 0.962 (95% CI 0.868 to 0.995) for PCT-based combination and 0.907 (95% CI 0.692 to 0.990) for presepsin-based combination.

Keywords: C-reactive protein; Invasive fungal infections; biomarkers; febrile neutropenia; presepsin; procalcitonin; sepsis.

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