Risk factor for death in hematopoietic stem cell transplantation: are biomarkers useful to foresee the prognosis in this population of patients?

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art_MASSARO_Risk_factor_for_death_in_hematopoietic_stem_cell_2014.PDF (197.99 KB)
Citações na Scopus
16
Tipo de produção
article
Data de publicação
2014
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
SPRINGER HEIDELBERG
Autores
MACEDO, R.
CASTRO, B. S. de
Citação
INFECTION, v.42, n.6, p.1023-1032, 2014
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
The morbidity and mortality in hematopoietic stem cell transplantation (HSCT) occur due to infectious complications and constitute the major clinical problems in HSCT recipients. The role of the use of biomarkers in post-HSCT patients is still controversial. To assess the serum values of biomarkers interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) and risk factors for post-HSCT death. Prospective study conducted in patients submitted to HSCT at a university hospital. Biomarkers (IL-6, PCT and CRP) were assessed on the day afebrile neutropenia was detected, in the febrile event, 24 and 72 h after fever onset and 48 h or 5 days if fever persisted. Patients were compared as to the death outcome within 30 days from the HSCT. Variables with p < 0.15 were included in the multivariate analysis model (MVA) that were performed for all patients included in the study and separated for autologous and allogeneic HSCT patients. 296 patients with ages ranging between 15 and 70 years, neutropenic, submitted to HSCT, being 216 (73 %) autologous and 80 (20 %) allogeneic were assessed. One hundred and ninety (64.2 %) patients presented fever after the transplantation and infection microbiologically controlled in 78 (26.4 %). Twenty-three cases (7.8 %) evolved to death. The risk factors associated with death in the bivariate analysis were age, allogeneic transplantation, unrelated transplantation, GVHD, bloodstream infection by Gram-negative, IL-6 > 140 pg/mL and CRP a parts per thousand yen120 mg/L and the protective ones were lymphoma and hospital outpatient support. The independent variables in the MVA associated with death were allogeneic and unrelated transplantation, blood stream infection (BSI) by Gram-negative, LDH a parts per thousand yen390 UI/L, urea a parts per thousand yen25 mg/dL and CRP a parts per thousand yen120 mg/L for HSCT transplanted patients and BSI due to Gram-negative and CRP a parts per thousand yen120 mg/L for allogeneic HSCT, however, CRP a parts per thousand yen120 mg/L did not remain in the model when urea a parts per thousand yen25 mg/L was included. No independent risk factor was found for autologous patients. Out of the biomarkers assessed, only CRP a parts per thousand yen120 mg/L was independently associated with death. Other risk factors found were: type of transplantation (allogeneic and unrelated), bloodstream infection by Gram-negative, LDH a parts per thousand yen390 UI/L and urea a parts per thousand yen25 mg/dL. For allogeneic patients only CRP a parts per thousand yen120 mg/L and BSI due to Gram-negative were risk factors for death; however, CRP did not remain in the model when urea a parts per thousand yen25 mg/L was included.
Palavras-chave
Hematopoietic stem cell transplantation, Febrile neutropenia, Mortality related to the hematopoietic stem cell transplantation, Procalcitonin, Interleukin-6, Creactive protein
URI
https://observatorio.fm.usp.br/handle/OPI/8880
Referências
  1. Anaissie E, 2012, OVERVIEW INFECTIONS
  2. Artz AS, 2008, BIOL BLOOD MARROW TR, V14, P1209, DOI 10.1016/j.bbmt.2008.08.004
  3. Azarpira N, 2009, EXP CLIN TRANSPLANT, V7, P115
  4. Bacigalupo A, 1999, BONE MARROW TRANSPL, V24, P653, DOI 10.1038/sj.bmt.1701953
  5. Blennow O, 2014, TRANSPL INFECT DIS, V16, P106, DOI 10.1111/tid.12175
  6. Blijlevens NMA, 2000, CLIN DIAGN LAB IMMUN, V7, P889, DOI 10.1128/CDLI.7.6.889-892.2000
  7. Brodska H, 2008, CRIT CARE, V13, P1
  8. Charles PE, 2009, CRIT CARE, V13, DOI 10.1186/cc7751
  9. Christ-Crain M, 2004, LANCET, V363, P600, DOI 10.1016/S0140-6736(04)15591-8
  10. EORTC International Antimicrobial Therapy Cooperative Group, 1989, AM J MED, V86, P668
  11. Fleischhack G, 2000, BRIT J HAEMATOL, V111, P1093, DOI 10.1046/j.1365-2141.2000.02458.x
  12. Freifeld AG, 2011, CLIN INFECT DIS, V52, P56
  13. Goldberg SL, 1998, J CLIN ONCOL, V16, P3796
  14. Gratwohl A, 2009, CANCER, V115, P4715, DOI 10.1002/cncr.24531
  15. Hughes WT, 2002, CLIN INFECT DIS, V34, P730, DOI 10.1086/339215
  16. Kanda J, 2010, BONE MARROW TRANSPL, V3, P1
  17. Koya J, 2012, BONE MARROW TRANSPL, V47, P1326, DOI 10.1038/bmt.2012.18
  18. LOVE LJ, 1980, AM J MED, V68, P643, DOI 10.1016/0002-9343(80)90243-0
  19. Mendes ET, 2012, INT J INFECT DIS, V16, P424
  20. Mikulska M, 2012, INFECTION, V40, P271, DOI 10.1007/s15010-011-0229-y
  21. Mori Y, 2011, INTERNAL MED, V50, P2149, DOI 10.2169/internalmedicine.50.5798
  22. OCHS L, 1995, BLOOD, V86, P3979
  23. Ortega M, 2004, BONE MARROW TRANSPL, V33, P741, DOI 10.1038/sj.bmt.1704409
  24. Pihusch M, 2006, EUR J HAEMATOL, V76, P93, DOI 10.1111/j.0902-4441.2005.t01-1-EJH2362.x
  25. Pinana JL, 2014, ANN HEMATOL, V93, P299, DOI 10.1007/s00277-013-1872-4
  26. PIZZO PA, 1982, AM J MED, V72, P101, DOI 10.1016/0002-9343(82)90594-0
  27. POLIQUIN CM, 1990, YALE J BIOL MED, V63, P495
  28. Ruokonen E, 1999, EUR J CLIN MICROBIOL, V18, P283
  29. Schots R, 2002, BONE MARROW TRANSPL, V30, P441, DOI 10.1038/sj.bmt.1703672
  30. Schots R, 2003, LEUKEMIA, V17, P1150, DOI 10.1038/sj.leu.2402946
  31. Simon L, 2004, CLIN INFECT DIS, V39, P206, DOI 10.1086/421997
  32. Sorely JS, 1997, INFECT DIS CLIN N AM, V11, P459
  33. Sudhoff T, 2000, CHEMOTHERAPY, V46, P77, DOI 10.1159/000007259

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - FM/MIP
Artigos e Materiais de Revistas Científicas - LIM/48
Artigos e Materiais de Revistas Científicas - LIM/54
Artigos e Materiais de Revistas Científicas - ODS/03