Measurement of C-reactive protein in adults with febrile neutropenia after hematopoietic cell transplantation

Summary:

The aim of this study was to evaluate the usefulness of C-reactive protein (CRP) monitoring in the differential diagnosis and prognosis of febrile neutropenic episodes in hematopoietic cell transplantation (HCT). In all, 100 patients were enrolled in the study. The CRP was determined in serum every 48 h from admission until resolution of the febrile episode. All patients presented with fever during the post-HCT neutropenic period. The febrile episodes were classified as microbiologically documented infection in 32 cases, clinically documented infection in 27 patients and fever of unknown origin in 41 patients. The mean CRP values on the first day of fever in these three groups were similar (NS). On the fifth day of antibiotic treatment, 50 patients remained pyrexial. Of these, 41 improved with modifications of antibiotherapy (mean CRP: 9.5 mg/dl; standard deviation (s.d.): 6.2) and nine died, five due to an infectious etiology (CRP: 21 mg/dl; s.d.: 4.4; P<0.003) and four from other causes (CRP: 11 mg/dl; s.d.: 3.4). On multivariate analysis, the CRP on the fifth day of treatment was an independent prognostic factor for fatal outcome. We conclude that persistent elevation of the CRP is an independent factor predicting a fatal outcome in patients who remain febrile on the fifth day of antibiotherapy during neutropenic febrile episodes post-HCT.