Sepsis biomarkers in neutropaenic systemic inflammatory response syndrome patients on standard care wards.

Background Neutropaenic patients are at a high risk of contracting severe infections. In particular, in these patients, parameters with a high negative predictive value are desirable for excluding infection or bacteraemia. This study evaluated sepsis biomarkers in neutropaenic patients suffering from systemic inflammatory response syndrome ( SIRS). Further, the predictive capacities of evaluated biomarkers in neutropaenic SIRS patients were compared to non-neutropaenic SIRS patients. Material and methods In this prospective observational cohort study, patients with clinically suspected sepsis were screened. The predictive capacities of procalcitonin ( PCT), C-reactive protein and lipopolysaccharide-binding protein ( LBP) in neutropaenic SIRS patients were evaluated in terms of their potential to identify infection or bacteraemia and were compared to results for non-neutropaenic SIRS patients. To select an appropriate control cohort, propensity score matching was applied, balancing confounding factors between neutropaenic and non-neutropaenic SIRS patients. Results Of 3370 prospectively screened patients with suspected infection, 51 patients suffered from neutropaenic SIRS. For the identification of infection, none of the assessed biomarkers presented a clinically relevant discriminatory potency. Lipopolysaccharide-binding protein and PCT demonstrated discriminatory capacity to discriminate between nonbacteraemic and bacteraemic SIRS in patients with neutropaenia [receiver-operating characteristics-area under the curves ( ROC- AUCs): 0·860, 0·818]. In neutropaenic SIRS patients, LBP had a significantly better ROC- AUC than in a comparable non-neutropaenic patient cohort for identifying bacteraemia ( P = 0·01). Conclusion In neutropaenic SIRS patients, none of the evaluated biomarkers was able to adequately identify infection. LBP and PCT presented a good performance in identifying bacteraemia. Therefore, these markers could be used for screening purposes to increase the pretest probability of blood culture analysis. [ABSTRACT FROM AUTHOR]