Early detection of infectious complications during induction therapy for acute leukemia with serial C-reactive protein biomarker assessment

Abstract

Febrile neutropenia (FN) and blood stream infections (BSI) are major complications of induction treatment for acute leukemia. We assessed the predictive utility of C-reactive protein (CRP), an acute phase reactant, for FN and BSI during induction. CRP levels and dynamics were analyzed in 138 consecutive patients. FN and BSI occurred in 110 (80.3%) and 10 (7.5%) patients, respectively. Median peak CRP level in the 24-hours preceding FN was 7.5 mg/dl (0.2–38.1) vs. median peak CRP level of 5.11 mg/dl (0.2–23.1, p = .009) in patients without FN. CRP levels preceding BSI were 13.1 mg/dl (6.9–27.9) vs. 6.3 mg/dl (0.16–38.14, p = .011). CRP increase prior to event (ΔCRP) was higher among patients with BSI vs. patients without BSI (p = .013). CRP was predictive for FN (p = .009) and BSI (p = .01) on ROC curve analysis and was also independently associated with FN on multivariate analysis. In conclusion, CRP is a sensitive biomarker that precedes FN and BSI.

Keywords:

• Acute leukemia
• induction therapy
• C-reactive protein
• febrile neutropenia
• blood stream infection

Disclosure statement

The authors declare no competing financial interests for this study.

Author contributions

S.S, M.Y, P.R, and O.W designed the study. S.S, U.R and N.S collected the data, S.S, U.R and D.Y analyzed the data. S.S and O.W. wrote the paper. All authors reviewed, revised and approved the paper.