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Yu J, Shi X, Ma J, Chen R, Dong S, Lu S, Wu J, Yan C, Wu J, Zheng S, Li L, Xu X, Cao H. C-Reactive Protein Is an Independent Predictor of 30-Day Bacterial Infection Post-Liver Transplantation. Biomolecules 2021; 11:biom11081195. [PMID: 34439862 PMCID: PMC8391373 DOI: 10.3390/biom11081195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
The relationship between aseptic systemic inflammation and postoperative bacterial infection is unclear. We investigated the correlation of systemic inflammation biomarkers with 30-day clinically significant bacterial infections (CSI) after liver transplantation (LT). This retrospective study enrolled 940 patients who received LT and were followed for 30 days. The primary end point was 30-day CSI events. The cohort was divided into exploratory (n = 508) and validation (n = 432) sets according to different centers. Area under the receiver operated characteristic (AUROC) and Cox regression models were fitted to study the association between baseline systemic inflammation levels and CSI after LT. A total of 255 bacterial infectious events in 209 recipients occurred. Among systemic inflammation parameters, baseline C-reactive protein (CRP) was independently associated with 30-day CSI in the exploratory group. The combination of CRP and organ failure number showed a good discrimination for 30-day CSI (AUROC = 0.80, 95% CI, 0.76–0.84) and the results were confirmed in an external verification group. Additionally, CRP levels were correlated with bacterial product lipopolysaccharide. In conclusion, our study suggests that pre-transplantation CRP is independent of other prognostic factors for 30-day CSI post-LT, and can be integrated into tools for assessing the risk of bacterial infection post-LT or as a component of prognostic models.
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Affiliation(s)
- Jiong Yu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
| | - Xiaowei Shi
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China; (R.C.); (S.D.); (J.W.)
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jing Ma
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
| | - Ronggao Chen
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China; (R.C.); (S.D.); (J.W.)
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Siyi Dong
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China; (R.C.); (S.D.); (J.W.)
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Sen Lu
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;
| | - Jian Wu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
| | - Cuilin Yan
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
| | - Jian Wu
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China; (R.C.); (S.D.); (J.W.)
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shusen Zheng
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China; (R.C.); (S.D.); (J.W.)
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Lanjuan Li
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
| | - Xiao Xu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China; (R.C.); (S.D.); (J.W.)
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Correspondence: (X.X.); (H.C.)
| | - Hongcui Cao
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou 310003, China; (J.Y.); (X.S.); (J.M.); (J.W.); (C.Y.); (S.Z.); (L.L.)
- National Clinical Research Center for Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
- Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Rd., Hangzhou 310003, China
- Correspondence: (X.X.); (H.C.)
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Kollu V, Mott SL, Khan R, Farooq U, Jethava Y, Dilek I, Tricot G. C-Reactive Protein Monitoring Predicts Neutropenic Fever Following Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma. Cureus 2018; 10:e2945. [PMID: 30202676 PMCID: PMC6128584 DOI: 10.7759/cureus.2945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Neutropenic fever (NF) is a known and common complication of autologous hematopoietic stem cell transplantation (ASCT). Early risk assessment may help direct treatment. We retrospectively analyzed the role of serial serum C-reactive protein (CRP) levels in predicting NF and assessed the clinical value of CRP within 14 days after transplantation. Methods One hundred twenty-one multiple myeloma (MM) patients received 170 first and/or second ASCT between January 2014 and March 2017. A Cox regression model was applied to assess the prognostic value of CRP as a time-dependent covariate at the onset of NF within 14 days post-transplant. Results Forty-seven of 170 patients developed NF. High CRP levels (4.0–43.2 mg/dL) were associated with a 5.45-fold increased risk of NF (P = 0.02). Patients had a nearly three-fold increased risk of NF after the second transplant (P < 0.01), but this was not associated with increased mortality. Those with NF had higher maximum values of CRP (P < 0.01) which tended to occur at or after the onset of NF. Conclusion CRP monitoring provides important information about the risk for NF immediately after first MM ASCT, and even more so after the second.
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Affiliation(s)
- Vidya Kollu
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Sarah L Mott
- Biostatistics/Holden Comprehensive Cancer Center, University of Iowa, Iowa City, USA
| | | | - Umar Farooq
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | | | - Ince Dilek
- Internal Medicine, University of Iowa, Iowa City, USA
| | - Guido Tricot
- Internal Medicine, University of Iowa, Iowa City, USA
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