Febril nötropeni olgularında mannoz bağlayan lektin, h-fikolin ve prokalsitonin düzeylerinde erken dönem değişimleri

WOS: 000392282500007PubMed ID: 26377840Objective: The significance of mannose-binding lectin (MBL) and H-ficolin deficiency in febrile neutropenic (FN) patients and the correlation of these markers along with consecutive C-reactive protein (CRP) and procalcitonin (PCT) levels during the infectious process are investigated. Materials and Methods: Patients with any hematological malignancies who were defined to have "microbiologically confirmed infection", "clinically documented infection", or "fever of unknown origin" were included in this single-center prospective observational study. Serum levels of CRP, PCT, MBL, and H-ficolin were determined on 3 separate occasions: at baseline (between hospital admission and chemotherapy), at the onset of fever, and at the 72nd hour of fever. Results: Forty-six patients (54% male, mean age 41.7 years) with 61 separate episodes of FN were evaluated. Eleven patients (23.9%) had "microbiologically confirmed infection", 17 (37%) had "clinically documented infection", and 18 (39.1%) had "fever of unknown origin". Fourteen (30.4%) patients had low (<500 ng/mL) initial MBL levels and 7 (15.21%) had low (<12,000 ng/mL) H-ficolin levels. Baseline MBL and H-ficolin levels did not significantly change on the first and third days of fever (p=0.076). Gram-negative bacteremia more frequently occurred in those with low initial MBL levels (p=0.006). PCT levels were significantly higher in those with microbiologically documented infections. Mean and median PCT levels were significantly higher in cases with bacteremia. There was no significant difference between hemoculture-positive and-negative patients in terms of CRP levels. Conclusion: Monitoring serum H-ficolin levels was shown to be of no benefit in terms of predicting severe infection. Low baseline MBL levels were correlated with high risk of gram-negative bacteremia; however, no significant correlation was shown in the follow-up. Close monitoring of PCT levels is warranted to provide more accurate and specific data while monitoring cases of bacteremia.Amaç: Febril nötropenik (FEN) hastalarda mannoz-bağlayıcı lektin (MBL) ve H-fikolin eksikliğinin önemi ve bu belirteçlerin enfeksiyon atağı sırasında ardışık C-reaktif protein (CRP) ve prokalsitonin (PCT) ölçümleri ile korelasyonu araştırılmıştır. Gereç ve Yöntemler: Bu tek merkezli prospektif gözlemsel çalışmaya, hematolojik malignite nedeniyle izlenen ve “mikrobiyolojik olarak doğrulanmış enfeksiyon”, “klinik olarak dökümante edilmiş enfeksiyon” veya “nedeni bilinmeyen ateş” tanıları konulan hastalar dahil edilmiştir. Serum CRP, PCT, MBL ve H-fikolin düzeyleri; başlangıçta (hastaneye başvuru ile kemoterapi başlangıcı arasında), ateş atağının başında ve 72. saatinde olmak üzere üç ayrı zamanda ölçülmüştür. Bulgular: Kırk altı (%54 erkek, ortalama yaş 41,7) hastada gelişen 61 ayrı FEN atağı değerlendirildi. Hastaların 11’inde (%23,9) “mikrobiyolojik doğrulanmış enfeksiyon”, 17’sinde (%37) “klinik dökümante enfeksiyon”, 18’inde (%39,1) ise nedeni bilinmeyen ateş mevcut idi. Başlangıç MBL düzeyi (<500 ng/mL) yedi hastada, H-fikolin düzeyi ise (