The Diagnostic Value Of Procalcitonin?c-reactive Protein And Body Temperature In The Stage After Anti-thymocyte Globulin (ATG) In Conditioning Of Hematopoietic Stem Cell Transplantation

Backgroud:Bacterial infection is one of the most common reasons of early complication and high mortality after hematopoietic stem cell transplant.In neutropenic patients with fever in early stage,it is very difficult to accurately differentiate between bacterial and viral infection and also between infectious and non infectious inflammatory reaction.The incidence of infection,severity and treatment effects are associated with the use of immunosuppressive agents.The neutropenic patients likely to develop sepsis so efficient and early use of antibiotic is very necessary to prevent complications.Although the routine monitoring of plasma procalcitonin?PCT?,C-reactive protein?CRP?and temperature?T?help to determine the infection,but we found that almost in every patient during conditioning stage using antithymocyte globulin?ATG?on the first day was almost always accompanied by high fever,infection index of PCT and CRP significantly were increased,but the clinical manifestation were not according to severe infection so we have difficulties to accurately diagnose the infection with the onset of fever.To avoide inappropriate use of antibiotics,we carried out this study,we monitor PCT,CRP and temperature T to find out the role of these in the diagnosis of infection.Objects:To find out whether PCT,CRP and T are helpful to distinguish bacterial infection and non-bacterial inflammation after the use of anti-thymocyte globulin?ATG?during conditioning of hematopoietic stem cell transplantation?HSCT?.Method:This study included 60 cases of severe thalassemia patients,who underwent hematopoietic stem cell transplantation,pretreated with chemotherapy including cyclophosphamide,fludarabine,IV Busufan,thiotepa and antithymocyte globulin?total dose were Thymoglobuline ATG 5mg/kg or Fresenius ATG-F 15-30mg/kg,divided in 3 doses from-3 day to₁ day before transplantation?.We took blood samples every morning to check PCT and CRP,and we also monitor daily temperature from-3 day to 0 day.We divided the patients into 4 groups.Group 1?G1,with antibiotics,n=30?,Group 2?G2,without antibiotics,n=30?,Group 3?G3,bacteria culture positive,n=7?and Group 4?G4,bacteria culture negative,n=47?.In 6 cases we didn't do the blood culture for 1 week.We use ANOVA for repeated measure data for comparison and the receiver operating characteristic curve?ROC?according to the values of PCT,CRP and T were made respectively,besides that,the area under the ROC curve?AUC?were also calculated.Results:1.PCT value of G1 and G2 had the same trend during all 4 days.No interaction between treatment and time?F=1.570,P=0.208?,the difference between the two groups have no statistical significance?P = 0.061?,G3 and G4 had different changing trends.There was interaction between blood culture result and time?F=3.747,P = 0.021?,but differences between the two groups at each time point had no significance?P?0.058?.2.CRP values of G1 and G2 had different trends,within each time point between the two groups had statistical significance?P<0.048?;CRP value of G3 and G4 had different trends with each time point except day-3,differences between the two groups was not significant?P>0.158?.3.Body temperature?T?value of G1 and G2 had the same trend during all 4 days,the difference was statistically significant?P=0.000?;temperature?T?of G3 and G4 had the same value trend,the difference was not statistically significant?P=0.377?.4.The area under the ROC curve?AUC?of PCT,CRP and T value were small?less than 0.722?.They had little diagnostic significance.Conclusion:1.At present,this study shows that in patients with HSCT,conditioned with ATG,monitoring of PCT and CRP value and temperature to distinguish between bacterial infection and non infectious inflammatory reaction have low diagnostic value.2.In Group 4 on-2 day PCT value was higher than Group 3,Iindicate that PCT was mainly affected by ATG in Group 4.but in culture +ve group first PCT value was not high but have a rebount increase on day 0.In non-infection group showed a declining trend day by day.3.Although the diagnostic value of CRP is not high,but we observe a rise in CRP value in both culture +ve and culture-ve group.In group 3 the CRP value keep on increasing while in group 4 after-2 day no significant change in CRP value may indicate no infection.4.There is no significant difference in temperature trend in both culture +ve and culture-ve group indicate that the high fever on-3day was mainly due to ATG,while in antibiotic group and in non antibiotic group there was a significant difference in temperature trend,high by 0.3 degree celcius in antibiotic group so just with the onset of fever sometime we may make wrong decision to use the antibiotic.