Biomarkers Affecting Treatment Outcomes of Febrile Neutropenia in Hematological Patients with Lymphomas: Is Presepsin the New Promising Diagnostic and Prognostic Biomarker?

Abstract

Background/Objectives: In hematological patients receiving treatment for lymphomas, febrile neutropenia (FN) is a serious complication associated with significant morbidity and mortality. This prospective study aimed to evaluate the diagnostic and prognostic value of the novel biomarker presepsin (PSP) in episodes of FN in this specific cohort of patients. Methods: The study enrolled 37 patients with FN and 18 patients with neutropenia without fever as a control group. Patients with FN were divided into two groups: those with confirmed infections and those without them. Various clinical and laboratory parameters were analyzed, including inflammatory and biochemical markers, focusing on implications of PSP. Results: Among patients with FN, 65% had proven infections with significantly higher PSP levels compared to those without infections and control group (p < 0.001). Positive blood cultures were found in 13.5% of all FN episodes. PSP showed greater sensitivity than traditional biomarkers like procalcitonin and C-reactive protein for differentiating septic from non-septic complications. Increased PSP levels at admission suggested a poorer survival prognosis. Each 1 ng/mL increase in PSP correlated with a 5% increase in mortality risk (HR 1.05; p < 0.001), with a one-year mortality rate of 56.7%, underscoring the necessity for better predictive markers. Other markers, including CRP, PCT, IgG, and albumin, were not significantly associated with mortality; however, platelets and qSOFA exhibited borderline significance. Conclusions: PSP is a valuable biomarker for identifying high-risk FN in lymphoma patients and predicting mortality, correlating with infection severity. Larger multi-center studies are needed to validate these findings and optimize PSP's clinical application to improve outcomes.

Keywords: febrile neutropenia; lymphomas; presepsin; prognosis.

Figure 1

The box-and-whisker plot displaying PSP values between 3 patient groups. The square on the plot represents the mean value, while the horizontal line indicates the median PSP value. Values for each group are in the text, with upper and lower quartiles being 4.47 and 27.8 (group I), 2.15 and 6.85 (group N), and 0.09 and 0.22 (group C).

Figure 2

Correlations between PSP levels at baseline measurement and CRP and PCT levels for the entire patient group. A positive correlation was observed between all parameters: (A) the correlation between PSP and CRP (r = 0.656; p < 0.001); (B) the correlation between PSP and PCT (r = 0.601; p < 0.001); (C) the correlation between CRP and PCT (r = 0.441; p = 0.019).

Figure 3

Correlations between the concentration PSP and the number of absolute neutrophil count (ANC) (r = −0.412; p = 0.002; (A)), concentration of albumin (r = −0.607; p <0.001; (B)), IgG levels (r = −0.500; p = <0.001; (C)), and CD4+ levels (r = 0.440; p = 0.009; (D)) in the overall sample.

Figure 4

Although both the means (boxes on the chart above) as well as medians (thick lines) of the PSP concentrations differed visibly across the qSOFA scoring parameter groups, these differences were not statistically significant (p = 0.733), most likely due to many outlier and extreme measurements notable on the chart. Values for each group are in the text, with upper and lower quartiles being 2.93 and 7.19 (group I), 3.03 and 25.1 (group N), and 2.43 and 28.9 (group C).

Figure 5

Differences in mean (box) and median (thick horizontal line) values of PSP between deceased and surviving groups for groups I (blue), N (grey), and C (yellow).

Figure 6

Kaplan−Meier analysis of survival between groups I and N ((A); p = 0.241); by gender ((B); p = 0.258); presence of CVC ((C); p < 0.001); and age ((D); p = 0.620).