Chitotriosidase and Neutrophil Gelatinase-Associated Lipocalin: New Methods as a Diagnostic Marker of Infection in Patients with Febrile Neutropenia?

Abstract

Objectives: Despite the important improvements in prevention and treatment, febrile neutropenia is still a common challenge in patients with certain hematological disorders. Many biomarkers have been explored to identify high-risk neutropenic patients, which need hospitalization and broad-spectrum antibiotic treatment. In the present study, firstly, we aimed to investigate serum CRP, Chitotriosidase (CtH) and Neutrophil gelatinase-associated lipocalin level (NGAL) in febrile neutropenia, non-febrile neutropenia and control groups. Secondly, to evaluate the usefulness of CRP, CtH and NGAL as a inflammatory biomarker to detect slight inflammatory change associated with infection in these patients. Methods: This was a single center prospective study that investigated ChT and NGAL as a new biomarkers to detect slight inflammatory change associated with infection in febrile neutropenia, non-febrile neutropenia and control groups. Therefore, 168 serum samples, which were obtained from 26 patients with hematological disorders were divided into three groups; Febrile neutropenia, non-febrile neutropenia and control group. Results: The mean serum CRP, CtH and NGAL levels of febrile neutropenia group were significantly higher than the other two groups (p<0.05). However, there was not any statistically significant difference between non-febrile neutropenia and control groups (P>0.05). C-reactive protein had a positive and significant correlation with CtH (r=0.548, p<0. 05) and NGAL (r=0.311, p<0.05). Moreover, there was a positive and significant correlation between CtH and NGAL (r=0.247, p<0. 05). The area under the curve (AUC) values were found as 0.68 (0.48–0.79), 0.72 (0.56–0.87), 0.72 (0.56– 0.87), 0.56 (0.39–0.66) for CRP, CtH and NGAL respectively and there was not any significant difference between any two AUC values (p>0.05). Conclusion: Serum ChT level is the most sensitive and specific biomarker to detect slight inflammatory change associated with infection in febrile neutropenic patients. Therefore, in the future, it may be used instead of or in combination with CRP to discriminate critically ill patients, to prevent unnecessary hospitalization and antibiotic treatment in neutropenia.