C-Reactive Protein as A Fungal Infection Marker in Acute Leukemia Patients

Brigitte Rina Aninda Sidharta, JB. Suparyatmo, Avanti Fitri Astuti

Abstract


Invasive Fungal Infections (IFIs) can cause serious problems in cancer patients and may result in high morbidity and
mortality. C-reactive protein levels increase in response to injury, infection, and inflammation. C-reactive protein increases
in bacterial infections (mean of 32 mg/L) and in fungal infections (mean of 9 mg/L). This study aimed to determine
C-Reactive Protein (CRP) as a marker of fungal infections in patients with acute leukemia by establishing cut-off values of
CRP. This study was an observational analytical study with a cross-sectional approach and was carried out at the Department
of Clinical Pathology and Microbiology of Dr. Moewardi Hospital in Surakarta from May until August 2019. The inclusion
criteria were patients with acute leukemia who were willing to participate in this study, while exclusion criteria were patients
with liver disease. There were 61 samples consisting of 30 male and 31 female patients with ages ranging from 1 to 70 years.
Fifty-four patients (88.5%) were diagnosed with Acute Lymphoblastic Leukemia (ALL) and 30 (49.18%) were in the
maintenance phase. The risk factors found in those patients were neutropenia 50-1500 μL (23.8%), use of intravenous line
(22%), and corticosteroid therapy for more than one week (20.9%). The median of CRP in the group of patients with positive
culture results was 11.20 mg/L (11.20-26.23 mg/L) and negative culture results in 0.38 mg/L (0.01-18.63 mg/L). The cut-off
value of CRP using the Receiver Operating Curve (ROC) was 9.54 mg/L (area under curve 0.996 and p. 0.026), with a sensitivity
of 100%, specificity of 93.2%, Positive Predictive Value (PPV) of 33.3%, Negative Predictive Value (PPV) of 100%, Positive
Likelihood Ratio (PLR) of 1.08, Negative Likelihood Ratio (NLR) of 0 and accuracy of 93.4%. C-reactive protein can be used as
a screening marker for fungal infections in patients with acute leukemia.


Keywords


Leukemia, C-reactive protein

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References


Forman D, Ferlay J. The global and regional burden of

cancer. In: Stewart BW, and Wild CP. World cancer

report 2014. International agency for research on

cancer. Switzerland, WHO Press, 2014; 16-20.

Almeida ALS, de Azevedo IC, Carvalho DPSRP, Vitor AF,

Santos VEP, Ferreira Jr MA. Clinical and

epidemiological aspects of leukemias. Revista Cubana

de Hematología, Inmunol y Hemoter, 2017; 33(2): 1-14.

Fiegl M. Epidemiology, pathogenesis, and etiology of

acute leukemia. In: Hiddemann W. Handbook of acute

leukemia. Switzerland, Springer International

P u b l i s h i n g . A v a i l a b l e f r o m : h t t p : / / w w w .

springer.com/978-3-31926770: 2016; 1-12 (accessed

Des, 2018).

Lehmbecher T, Schoning S, Poyer F, Georg J, Becker A,

et al. Incidence and outcome of invasive fungal disease

in children with hematological malignancies and/or

allogeneic hematopoietic stem cell transplantation:

results of a prospective multicenter study. Frontier in

Microbiology, 2019; 10: 1-9.

Gulhan B, Yukses SK, Parlakay AO, Yarah N, Tezer H,

Ozbek Y. Invasive fungal infection in children with

hematologic malignancy. The Turkish Journal of

Pediatric. 2019; 61: 159-165.

Yilmaz E, Erdogmus A, Ozcan A, Gorkem SB, Ceylan O,

et al. Invasive fungal infections in children with acute lymphoblastic leukemia: Experience from a reference

University Hospital in Cappadocia. International

Journal of Hematology and Oncology, 2020; 3(30):

-132.

Guo T, Ye Y, Huang L, Cheng B. Recurrent fever of

unknown fungal infection in low-risk patient (case

report). Medicine, 2019; 98(33): 1-4.

Tisi MC, Hohaus S, Cuccaro A, Innocenti I, De Carolis E,

et al. Invasive fungal infection in chronic

lymphoproliferative disorders: A monocentric

retrospective study (letters to the editor). 2017;

(e110): 1-4.

Salazar J, Martínez MS, Chávez-Castillo M, Núñez V,

Añez R, et al. C-reactive protein: An in-depth look into

structure, function, and regulation. Hindawi Publishing

Corporation International Scholarly Research Notices,

; 2014: 11.

Akin H, Akalin H, Budak F, Ener B, Ocakoglu G, et al.

Alteration of serum cytokine level and their relation

with inflammatory marker in Candidemia. Medical

Mycology, 2015; 53: 258-268.

Wadgera N, Yadhav MLK. Control and prevention of

AIDS, STDs and STIs. J AIDS Clin Res, 2017; 8(6): 1.

Hazar AF, Tucker H. Which biomarkers help to

distinguish between candida and aspergillus in

st patients with pulmonary infections?. South. Clin. I .

Euras, 2018; 29(3): 168-175.

Li J, Smith A, Crouch S, Oliver S, Roman E. Estimating

the prevalence of hematological malignancies and

precursor condition using data from Hematological

Malignancy Research Network (HMRN). Cancer

Causes Control, 2016; 27: 1019-1026.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA,

Jemal A. Global cancer statistics 2018: GLOBOCAN

estimates of incidence and mortality worldwide for 36

cancers in 185 countries. Cancer J Clin, 2018; 68:

-424.

Pagano L, Mayor S. Invasive fungal infection in high-risk

patients: Report from TIMM-8 2017. Future Sci. OA,

; 04(06): 1-10.

Papachristou S, Iosifidis E, Roilides E. Invasive

aspergilosis in pediatric leukemia patients: Prevention

and treatment. J Fungi, 2019; 5(14): 1-21.

Abbas E, Sidharta BRA, Kurniati A. Performa diagnostik

real time PCR dalam mendeteksi infeksi jamur pada

pasien lekemia akut dengan kemoterapi. Surakarta,

Karya akhir PPDS FK UNS, 2019; 51.




DOI: http://dx.doi.org/10.24293/ijcpml.v27i2.1639

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