International Journal of Hematology

, Volume 108, Issue 2, pp 184–191 | Cite as

Presepsin as a diagnostic marker of bacterial infections in febrile neutropenic pediatric patients with hematological malignancies

  • Ahmad BarakaEmail author
  • Marwa Zakaria
Original Article


Febrile neutropenia (FN) is often observed in hematological malignancies (HEM). Presepsin is also known as soluble CD14 subtype; it is a glycoprotein fragment derived from monocytes and macrophages. We aimed to evaluate the significance of presepsin and other biomarkers for diagnosis of bacteremia in children with HEM. Sixty pediatric patients with different HEM (acute lymphoblastic leukemia 36, acute myeloid leukemia 12, non-Hodgkin lymphoma 10, and Hodgkin disease 2). Thirty age and sex-matched healthy children serving as control were enrolled in this study. Estimation of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) during episode of FN in addition to absolute neutrophils count (ANC) and blood culture was performed for all the participants. Presepsin levels were higher in the patients than in control with a higher increments in the positive blood cultures than the sterile cases. Presepsin concentration was significantly higher in bacteremia than clinically proved infection and fever of unknown origin. A statistically significant positive correlation between presepsin and CRP plus PCT levels but negative correlation with ANC were observed in the patients subgroups. Presepsin is a useful marker for detection of bacteremia with sensitivity and specificity (100 and 85.7%). This finding supported that presepsin was superior to PCT and CRP in identifying bacterial infection in FN.


Hematological malignancies (HEM) Presepsin CRP PCT Febrile neutropenia 


Compliance with ethical standards

Conflict of interest

The authors indicated no potential conflict of interest.

Supplementary material

12185_2018_2447_MOESM1_ESM.docx (44 kb)
Supplementary material 1 (DOCX 43 kb)
12185_2018_2447_MOESM2_ESM.docx (24 kb)
Supplementary material 2 (DOCX 23 kb)


  1. 1.
    Lakshmaiah KC, Malabagi AS, Govindbabu S, Shetty R, Shetty M, Jayashree RS. Febrile neutropenia in hematological malignancies: clinical and microbiological profile and outcome in high risk patients. J Lab Phys. 2015;7(2):116–20.Google Scholar
  2. 2.
    Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febrile neutropenia: ESMO clinical practice guidelines. Ann Oncol. 2016;27(suppl 5):v111–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Villafuerte-Gutierrez P, Villalon L, Losa JE, Henriquez-Camacho C. Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update. Adv Hematol. 2014;2014:986938.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    El-Mahallawy HA, Hassan SS, El-Wakil M, Moneer MM, Shalaby L. Increasing antimicrobial resistance monitored in surveillance analysis of blood stream infections in febrile neutropenic pediatric oncology patients. Asian Pac J Cancer Prev. 2015;16(14):5691–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Kim DY, Lee YS, Ahn S, Chun YH, Lim KS. The usefulness of procalcitonin and C-reactive protein as early diagnostic markers of bacteremia in cancer patients with febrile neutropenia. Cancer Res Treat. 2011;43(3):176–80.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Qu J, Lu X, Liu Y, Wang X. Evaluation of procalcitonin, C-reactive protein, interleukin-6 & serum amyloid A as diagnostic biomarkers of bacterial infection in febrile patients. Indian J Med Res. 2015;141(3):315–21.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Shozushima T, Takahashi G, Matsumoto N, Kojika M, Okamura Y, Endo S. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome. J Infect Chemother. 2011;17(6):764–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Arai Y, Mizugishi K, Nonomura K, Naitoh K, Takaori-Kondo A, Yamashita K. Phagocytosis by human monocytes is required for the secretion of presepsin. J Infect Chemother. 2015;21(8):564–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Pugni L, Pietrasanta C, Milani S, Vener C, Ronchi A, Falbo M, et al. Presepsin (soluble CD14 subtype): reference ranges of a new sepsis marker in term and preterm neonates. PLoS ONE. 2015;10(12):e0146020.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bochennek K, Hassler A, Perner C, Gilfert J, Schöning S, Klingebiel T, et al. Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial AML-BFM 2004. Blood Cancer J. 2016;6(1):e382.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Badiee P, Zareifar S, Haddadi P, Jafarian H. Incidence of fungal infections in pediatric patients with hematologic neoplasms. Arch Pediatr Infect Dis. 2017; e41317 (in press).Google Scholar
  12. 12.
    Olad E, Sedighi I, Mehrvar A, Tashvighi M, Fallahazad V, Hedayatiasl A, et al. Presepsin (Scd14) as a marker of serious bacterial infections in chemotherapy induced severe neutropenia. Iran J Pediatr. 2014;24(6):715–22.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Jimeno A, García-Velasco A, del Val O, González-Billalabeitia E, Hernando S, Hernández R, et al. Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia. Cancer. 2004;100(11):2462–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients with cancer. Dent Clin N Am. 2008;52(1):61-viii.CrossRefGoogle Scholar
  15. 15.
    Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):427–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Masson S, Caironi P, Spanuth E, Thomae R, Panigada M, Sangiorgi G, et al. Prespsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial. Crit Care. 2014;18(1):R6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Koizumi Y, Shimizu K, Shigeta M, Okuno T, Minamiguchi H, Kito K, et al. Plasma presepsin level is an early diagnostic marker of severe febrile neutropenia in hematologic malignancy patients. BMC Infect Dis. 2017;17:27.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Viscoli C, Varnier O, Machetti M. Infections in patients with febrile neutropenia: epidemiology, microbiology, and risk stratification. Clin Infect Dis. 2005;40(Suppl 4):S240–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Castagnola E, Fontana V, Caviglia I, Caruso S, Faraci M, Fioredda F, et al. A prospective study on the epidemiology of febrile episodes during chemotherapy-induced neutropenia in children with cancer or after hemopoietic stem cell transplantation. Clin Infect Dis. 2007;45:1296–304.CrossRefPubMedGoogle Scholar
  20. 20.
    Kitanovski L, Jazbec J, Hojker S, Dergancet M. Diagnostic accuracy of lipopolysaccharide-binding protein for predicting bacteremia/clinical sepsis in children with febrile neutropenia: comparison with interleukin-6, procalcitonin, and C-reactive protein. Support Care Cancer. 2014;22(1):269–77.CrossRefPubMedGoogle Scholar
  21. 21.
    Rintala E, Irjala K, Nikoskelainen J. Value of measurement of C-reactive protein in febrile patients with hematological malignancies. Eur J Clin Microbiol Infect Dis. 1992;11(11):973–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Ebihara Y, Kobayashi K, Ishida A, Maeda T, Takahashi N, Taji Y, et al. Diagnostic performance of procalcitonin, presepsin, and C-reactive protein in patients with hematological malignancies. J Clin Lab Anal. 2017;2017:e22147.CrossRefGoogle Scholar
  23. 23.
    Endo S, Suzuki Y, Takahashi G, Shozushima T, Ishikura H, Murai A, et al. Usefulness of presepsin in the diagnosis of sepsis in a multicenter prospective study. J Infect Chemother. 2012;18(6):891–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Ulla M, Pizzolato E, Lucchiari M, Loiacono M, Soardo F, Forno D, et al. Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study. Crit Care. 2013;17(4):R168.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Korpelainen S, Intke C, Hämäläinen S, Jantunen E, Juutilainen A, Pulkki K. Soluble CD14 as a diagnostic and prognostic biomarker in hematological patients with febrile neutropenia. Dis Mark. 2017. (article ID 9805609, 8 pages).CrossRefGoogle Scholar
  26. 26.
    Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006;34(7):1996–2003.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2018

Authors and Affiliations

  1. 1.Department of Clinical Pathology, Faculty of MedicineZagazig UniversityZagazigEgypt
  2. 2.Department of Pediatric, Faculty of MedicineZagazig UniversityZagazigEgypt

Personalised recommendations