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 commonchallenge in patients with certain hematological disorders. Many biomarkers have been explored to identify high-riskneutropenic 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) infebrile neutropenia, non-febrile neutropenia and control groups. Secondly, to evaluate the usefulness of CRP, CtH andNGAL 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 detectslight inflammatory change associated with infection in febrile neutropenia, non-febrile neutropenia and controlgroups. Therefore, 168 serum samples, which were obtained from 26 patients with hematological disorders were dividedinto 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 theother two groups (p<0.05). However, there was not any statistically significant difference between non-febrile neutropeniaand 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 twoAUC values (p>0.05).Conclusion: Serum ChT level is the most sensitive and specific biomarker to detect slight inflammatory change associatedwith infection in febrile neutropenic patients. Therefore, in the future, it may be used instead of or in combination withCRP to discriminate critically ill patients, to prevent unnecessary hospitalization and antibiotic treatment in neutropenia.