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

Authors

  • Brigitte Rina Aninda Sidharta Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta
  • JB. Suparyatmo Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta
  • Avanti Fitri Astuti Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta

DOI:

https://doi.org/10.24293/ijcpml.v27i2.1639

Keywords:

Leukemia, C-reactive protein

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.

Downloads

Download data is not yet available.

Author Biographies

Brigitte Rina Aninda Sidharta, Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta

Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta

JB. Suparyatmo, Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta

Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta

Avanti Fitri Astuti, Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta

Department of Clinical Pathology, Faculty of Medicine, Sebelas Maret University/Dr. Moewardi Hospital, Surakarta

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 10 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): 126-132.

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; 102(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; 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: 394-424.

Pagano L, Mayor S. Invasive fungal infection in high-risk patients: Report from TIMM-8 2017. Future Sci. OA, 2018; 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.

Downloads

Submitted

2020-03-11

Accepted

2021-01-06

Published

2021-04-15

How to Cite

[1]
Sidharta, B.R.A., Suparyatmo, J. and Astuti, A.F. 2021. C-Reactive Protein as A Fungal Infection Marker in Acute Leukemia Patients. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 27, 2 (Apr. 2021), 212–216. DOI:https://doi.org/10.24293/ijcpml.v27i2.1639.

Issue

Section

Articles