Diagnostic value of CK-18 in adult AML patients with febrile neutropenia for the first time
Objective To investigate the diagnostic value of cytokeratin-18(CK-18)fragments cleaved from plasma cysteine-aspartate proteolytic enzymase-3 in adult acute myeloid leukemia(AML)patients with febrile neutropenia(FN)for the first time.Methods Seventy-five AML-FN patients who received intensive chemotherapy for hematologic tumors in the hematology ward of the Zhangjiagang First People's Hospital from November 2017 to December 2021 were collected.Plasma CK-18 fragment M30,C-reactive protein(CRP),and procalcitonin(PCT)levels were measured at FN onset(d0),day 1(d1),and day 2(d2).The occurrence of bloodstream infections(BSI)and sepsis during chemotherapy was evaluated.Results Eight patients had sepsis and 25 patients had blood culture positive infection(BSI +).Plasma CK-18 levels in BSI(+)group peaked on d1 after fever.Higher plasma CK-18 levels at d1 and d2 are associated with BSI(+)and sepsis.In ROC curve analysis,the area under the curve(AUC)of d1 CK-18 predicted BSI(+)was the highest(0.832(95%CI:0.742-0.922),slightly higher than PCT and CRP(P<0.05).The AUC value of d1 CK-18 was also higher in predicting sepsis,slightly higher than PCT and CRP,and the difference was not statistically significant(P>0.05).The peak value of CK-18 was correlated with the peak value of PCT during d0～d2,and the correlation coefficient of BSI(+)patients(0.407)was higher than that of BSI(-)patients(0.182).Conclusion In patients with AML,plasma CK-18 fragment has been found to be a potential diagnostic marker for early BSI(+)and sepsis of FN.
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