Early Changes of Mannose-Binding Lectin, H-Ficolin, and Procalcitonin in Patients with Febrile Neutropenia: A Prospective Observational Study

Abstract

Objective: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.

Associations of ficolins and mannose-binding lectin with acute myeloid leukaemia in adults

“…Furthermore, data from several other studies (concerning patients with other leukaemias, or haematological malignancies in general) led to similar conclusions [41][42][43][44][45][46] . In contrast to our results presented here and in afore-mentioned recent paper 37 , some earlier reports suggested that low MBL (or associated genotypes) enhanced the risk for infections in such cases 31,32,36,[47][48][49][50] . Furthermore, it was demonstrated that L-asparaginase (used in ALL treatment) induces a marked decrease in MBL concentration, which was suspected to contribute to increased risk of febrile neutropenia with infection 51 .…”

“…Several earlier reports 31,32 suggested a lack of association of ficolin-2 and/or ficolin-3 with incidence of infections or febrile neutropenia in patients with various haematological cancers. However, low ficolin-2 was suggested to predict higher risk of development of sinusoidal obstruction syndrome (SOS) after allogeneic haemopoietic cell transplantation 33,34 while low ficolin-3 was considered a risk factor for febrile neutropenia (also accompanied with bacteremia) in children, treated with anti-cancer chemotherapy 35 .…”

The Diagnostic Value of Monocyte Chemoattractant Protein-1, Compared with Procalcitonin, C-reactive Protein, and Lactate in Bacteremia Estimation for Patients with Febrile Neutropenia

“…Even though lactate was the most specific marker in our study, we believe that its low sensitivity limits its use in the diagnosis of FN. Procalcitonin levels of febrile neutropenic patients significantly increased and procalcitonin levels can be applied for the early diagnosis of infection in neutropenic patients (12). Our results we obtained in compliance with other studies.…”

Associations of Ficolins With Hematological Malignancies in Patients Receiving High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantations

“…The profile of changes of ficolin-3 levels in patients was generally similar to that demonstrated for ficolin-2. No impact of ficolin-3 on incidence of infections or febrile neutropenia in adult patients with hematological malignancies was previously reported by Ameye et al (49), Kilpatrick et al (50), and Islak Mutcali et al (54). Low ficolin-3 concentration was however suggested to be a risk factor for febrile neutropenia (especially with bacteremia) in pediatric cancer patients treated with chemotherapy (55).…”