Summary
The value of C-reactive protein (CRP) determinations in the analysis of fever after allogeneic bone marrow transplantation (BMT) was studied prospectively by serial measurements of serum CRP levels during 30 BMT episodes in 28 children and adolescents. The treatments and procedures accompanying BMT did not elicit a significant CRP response. Fourty-three febrile episodes were registered and analyzed, without previous knowledge of the results of CRP determinations. The incidence of bacterial infection and acute graft-versus-host disease (GvHD) was low, 8/30 and 5/30, respectively. Raised CRP levels occurred only once in association with GvHD. A CRP level higher than 50 mg/l was not sensitive as an indicator of bacterial infection (4/8). A CRP level below 50 mg/l in the presence of fever, however, excluded bacterial infection with a specificity of 86% and a negative predictive value of 88%. When timed properly and interpreted together with clinical and microbiological findings, CRP measurements can be a valuable aid in the management of fever after BMT, especially as a negative predictor.
Zusammenfassung
In einer prospektiven Studie wurde durch Serien-Messungen der Spiegel von C-reaktivem Protein (CRP) im Serum während 30 Knochenmarktransplantationen bei 28 Kindern und Jugendlichen der Wert der CRP-Spiegel-Bestimmung für die Beurteilung von Fieber nach allogener Knochenmarktransplantation ermittelt. Therapien und Maßnahmen im Rahmen der Knochenmarktransplantation lösten keinen signifikanten CRP-Anstieg aus. Ohne Vorkenntnis der CRP-Spiegel wurden 43 Fieberepisoden analysiert. Bakterielle Infektionen und Graft-versus-Host-Disease traten nur in 8/30 beziehungsweise 5/30 Fällen auf. Nur einmal stieg das CRP im Zusammenhang mit einer Graft-versus-host-disease an. Ein Antieg des CRP-Spiegels über 50 mg/l war kein sensitiver Parameter für eine bakterielle Infektion (4/8). Dagegen war eine bakterielle Infektion mit einer Spezifizität von 86% und einem negativen prädiktiven Wert von 88% ausgeschlossen, wenn bei Fieber ein CRP-Serumspiegel von weniger als 50 mg/l vorlag. Bei entsprechender Koordination der Spiegelmessungen und Interpretation im Kontext klinischer und mikrobiologischer Befunde können die CRP-Spiegel eine Hilfe im therapeutischen Management von Fieber nach Knochenmarktransplantation darstellen, wobei ein negativer CRP-Wert vor allem ein wertvoller Parameter für den Ausschluß einer bakteriellen Infektion ist.
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De Bel, C., Gerritsen, E., de Maaker, G. et al. C-reactive protein in the management of children with fever after allogeneic bone marrow transplantation. Infection 19, 92–96 (1991). https://doi.org/10.1007/BF01645575
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DOI: https://doi.org/10.1007/BF01645575