Markers of intestinal mucositis to predict blood stream infections at the onset of fever during treatment for childhood acute leukemia.

Autor: Weischendorff S; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark. sarah.wegener.weischendorff@regionh.dk.; Institute for Inflammation Research, Center for Rheumatology and Spine Disease, Rigshospitalet, Copenhagen, Denmark. sarah.wegener.weischendorff@regionh.dk., Rathe M; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.; Department of Clinical Research, University of Southern Denmark, Odense, Denmark., Petersen MJ; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark., Weimann A; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark., Enevold C; Institute for Inflammation Research, Center for Rheumatology and Spine Disease, Rigshospitalet, Copenhagen, Denmark., Nielsen CH; Institute for Inflammation Research, Center for Rheumatology and Spine Disease, Rigshospitalet, Copenhagen, Denmark., Als-Nielsen B; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark., Nygaard U; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Moser C; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark., Müller K; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.; Institute for Inflammation Research, Center for Rheumatology and Spine Disease, Rigshospitalet, Copenhagen, Denmark.; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Leukemia [Leukemia] 2024 Jan; Vol. 38 (1), pp. 14-20. Date of Electronic Publication: 2023 Nov 02.
DOI: 10.1038/s41375-023-02077-7
Abstrakt: Despite chemotherapy-induced intestinal mucositis being a main risk factor for blood stream infections (BSIs), no studies have investigated mucositis severity to predict BSI at fever onset during acute leukemia treatment. This study prospectively evaluated intestinal mucositis severity in 85 children with acute leukemia, representing 242 febrile episodes (122 with concurrent neutropenia) by measuring plasma levels of citrulline (reflecting enterocyte loss), regenerating islet-derived-protein 3α (REG3α, an intestinal antimicrobial peptide) and CCL20 (a mucosal immune regulatory chemokine) along with the general neutrophil chemo-attractants CXCL1 and CXCL8 at fever onset. BSI was documented in 14% of all febrile episodes and in 20% of the neutropenic febrile episodes. In age-, sex-, diagnosis- and neutrophil count-adjusted analyses, decreasing citrulline levels and increasing REG3α and CCL20 levels were independently associated with increased odds of BSI (OR = 1.6, 1.5 and 1.7 per halving/doubling, all p < 0.05). Additionally, higher CXCL1 and CXCL8 levels increased the odds of BSI (OR = 1.8 and 1.7 per doubling, all p < 0.0001). All three chemokines showed improved diagnostic accuracy compared to C-reactive protein and procalcitonin. These findings underline the importance of disrupted intestinal integrity as a main risk factor for BSI and suggest that objective markers for monitoring mucositis severity may help predicting BSI at fever onset.
(© 2023. The Author(s).)
Databáze: MEDLINE
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