High pentraxin 3 level predicts septic shock and bacteremia at the onset of febrile neutropenia after intensive chemotherapy of hematologic patients

Abstract

We evaluated pentraxin 3 as a marker for complications of neutropenic fever in 100 hematologic patients receiving intensive chemotherapy. Pentraxin 3 and C-reactive protein were measured at fever onset and then daily to day 3. Bacteremia was observed in 19 patients and septic shock in 5 patients (three deaths). In comparison to C-reactive protein, pentraxin 3 achieved its maximum more rapidly. Pentraxin 3 correlated not only with the same day C-reactive protein but also with the next day C-reactive protein. High pentraxin 3 on day 0 was associated with the development of septic shock (P=0.009) and bacteremia (P=0.046). The non-survivors had constantly high pentraxin 3 levels. To conclude, pentraxin 3 is an early predictor of complications in hematologic patients with neutropenic fever. High level of pentraxin 3 predicts septic shock and bacteremia already at the onset of febrile neutropenia. (ClinicalTrials.gov Identifier: NCT00781040.).

Figures

Figure 1.

Pentraxin 3 and C-reactive protein (CRP) means with SEs from day 0 to day 3 according to the presence of bacteremia (upper panel) and septic shock (lower panel). Patient groups with bacteremia and septic shock are marked with continuous lines, and those with no bacteremia and no septic shock are marked with dash lines.

Figure 2.

ROC-curve analysis comparing pentraxin 3 (PTX3) (continuous line) and C-reactive protein (CRP) (dash line) predicting the development of bacteremia or septic shock on day 0. For PTX3 the area under the curve (AUC) was 0.68 (95% CI 0.56–0.81) with SD 0.06 and P value 0.011 to differentiate septic shock or bacteremia. For CRP the AUC was 0.69 (0.56–0.82) with SD of 0.07 and P value 0.008 to differentiate septic shock or bacteremia.