Markers of intestinal mucositis to predict blood stream infections at the onset of fever during treatment for childhood acute leukemia
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Markers of intestinal mucositis to predict blood stream infections at the onset of fever during treatment for childhood acute leukemia. / Weischendorff, Sarah; Rathe, Mathias; Petersen, Malene Johanne; Weimann, Allan; Enevold, Christian; Nielsen, Claus H.; Als-Nielsen, Bodil; Nygaard, Ulrikka; Moser, Claus; Müller, Klaus.
In: Leukemia, Vol. 38, 2024, p. 14–20.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Markers of intestinal mucositis to predict blood stream infections at the onset of fever during treatment for childhood acute leukemia
AU - Weischendorff, Sarah
AU - Rathe, Mathias
AU - Petersen, Malene Johanne
AU - Weimann, Allan
AU - Enevold, Christian
AU - Nielsen, Claus H.
AU - Als-Nielsen, Bodil
AU - Nygaard, Ulrikka
AU - Moser, Claus
AU - Müller, Klaus
N1 - Publisher Copyright: © 2023, The Author(s).
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
U2 - 10.1038/s41375-023-02077-7
DO - 10.1038/s41375-023-02077-7
M3 - Journal article
C2 - 37919603
AN - SCOPUS:85175548212
VL - 38
SP - 14
EP - 20
JO - Leukemia
JF - Leukemia
SN - 0887-6924
ER -
ID: 373885345