| Background and purpose Chemotherapy is a commonly used method in the treatment of malignant tumors,but malignant tumor after chemotherapy are prone to agranulocytosis(neutrophilic granulocyte count<0.5×10~9/L),a short period for the high incidence of nosocomial infection period.Once the infection occurs,not only affects the normal conduct of chemotherapy,but also increases the mortality of patients with malignant tumor,and the harm is serious.At present,there is no effective method to predict the infection of malignant tumor after chemotherapy,so it is necessary to find effective biological indicators to predict the infection of malignant tumor after chemotherapy.This study explored the value of Procalcitonin(PCT),C-reactive protein(CRP)and Neutrophil(NE)in predicting the infection in the granulocyte deficiency stage after chemotherapy for malignant tumors,so as to detect high-risk patients and infection as early as possible.Then it can guide the clinical prevention,control,and reduction the occurrence of infection in the granular deficiency stage after chemotherapy.Methods From January 2018 to June 2020,411 patients with granular deficiency pathy stage after chemotherapy were selected for a retrospective study.All subjects were divided into infected group(167 cases)and non-infected group(244 cases)according to whether infection occurred during the deficiency period.All patients were dynamic detection for PCT,CRP and NE biological indicators from before to after chemotherapy.All patients in the infection group received pathogen detection and drug susceptibility testing and anti-infective therapy.The following indexes were observed:(1)the differences of PCT,CRP and NE levels between the two groups(infected group and uninfected group)before and after chemotherapy.(2)Changes of PCT,CRP and NE indexes in the infection group before and after chemotherapy,3d after chemotherapy,1d of infection in the deficiency stage,7d of anti-infection treatment,and remission stage after chemotherapy.(3)The value curves of PCT,CRP and NE for predicting the infection in the granuloplasmic stage after chemotherapy were drawn based on Receiver Operating Characteristic(ROC)curve,and the predictive values of the three indexes were analyzed according to ROC curve.(4)Based on the results of pathogen detection,the characteristics of pathogen distribution in the granular deficiency stage of malignant tumor after chemotherapy were analyzed;The differences of PCT,CRP and NE between gram-negative bacteria and gram-positive bacteria patients were compared.ROC curves were drawn on this basis to analyze the value of each indicator in predicting gram-negative bacteria infection.(5)Based on the prognosis of patients with agranulocytosis infection after malignant tumor chemotherapy,the differences of PCT,CRP and NE in the 28-day survival group and the death group were compared,and ROC curves were drawn on this basis to analyze the value of each index in predicting the prognosis of agranulocytosis infection.Results(1)Before chemotherapy,there was no significant difference in PCT,CRP and NE between the two groups(P>0.05).After chemotherapy,PCT and CRP in the infected group were higher than those in the uninfected group,while NE was lower than those in the uninfected group,with statistical significance(P<0.05).(2)Three days after chemotherapy,PCT and CRP in infection group were higher than before chemotherapy,while NE was lower than before chemotherapy,and the difference was significant compared with that before chemotherapy(P<0.05).On the first day of granular deficiency infection,PCT and CRP in the infection group continued to increase,while NE continued to decrease,with significant differences compared with before chemotherapy(P<0.05).On the 7th day of anti-infective treatment,PCT and CRP in the infection group showed a decreasing trend,while NE showed an increasing trend,but there were still significant differences compared with before chemotherapy(P<0.05).In the remission stage after chemotherapy,PCT and CRP in the infection group continued to decrease,while NE continued to increase,similar to that before chemotherapy(P>0.05).(3)The area under the curve(AUC)of the combined detection of the three indicators for predicting agranulocytosis infection after chemotherapy for malignant tumors was the largest,which was 0.952,and the predictive sensitivity,specificity and accuracy were 100.00%,92.21%,97.27%;followed by PCT,AUC was 0.911,the best cut-off value was 1.76ng/m L,and the predictive sensitivity,specificity,and accuracy were 92.22%,93.03%,and 93.84%,respectively;again,NE,AUC was 0.897,and the optimal cut-off value was0.30×10~9/L,and the predictive sensitivity,specificity,and accuracy were 90.42%,92.21%,and 91.48%,respectively;the last was CRP,and the AUC was 0.860.The best cut-off value was 8.92 mg/L,and the predictive sensitivity was 8.92 mg/L,specificity and accuracy were 89.22%,90.57%and 90.02%,respectively.The predictive performance of the combined detection of the three indicators was significantly higher than that of the single detection of the three indicators(P<0.05).The predictive performance of PCT was higher than that of CRP and NE(P<0.05).(4)Among 167 patients with agranuloma infection after chemotherapy,gram-negative bacteria accounted for 52.09%,gram-positive bacteria accounted for 27.54%and fungi accounted for 20.37%.The NE counts of patients infected by gram-negative bacteria,gram-positive bacteria and fungi were similar(P>0.05).Compared with PCT of patients infected by different pathogenic bacteria,the order from high to low is Gram-negative bacteria,Gram-positive bacteria and fungi,and there is statistical difference between any two groups(P<0.05).Compared with CRP of patients infected by different pathogenic bacteria,the order from high to low is fungi,gram-negative bacteria and gram-positive bacteria,and there is a statistical difference between any two groups(P<0.05).The AUC of ROC curve predicted by PCT CRP is0.871,and the prediction sensitivity,specificity and accuracy are 88.24%,90.23%and89.82%respectively.The AUC of PCT ROC curve is 0.657,the best cut-off value is3.64ng/m L,and the prediction sensitivity,specificity and accuracy are 73.53%,82.71%and 80.84%respectively.The AUC of CRP ROC curve is 0.804,the best cut-off value is 12.10mg/L,and the prediction sensitivity,specificity and accuracy are82.35%,87.22%and 86.23%respectively.(5)Among 167 patients with agranulocytosis infection after tumor chemotherapy,34 patients died within 28 days,and the mortality rate was 20.36%.The levels of PCT and CRP in the death group were higher than those in the survival group,and the level of NE was lower than that in the survival group,with significant differences(P<0.05).The combined detection of PCT,CRP,and NE has the highest predictive performance,with an AUC of 0.936,and the predictive sensitivity,specificity,and accuracy of 100.00%,86.47%,and79.64%,respectively;followed by PCT,with AUC of 0.761,predictive sensitivity,specificity,and the accuracies were 76.47%,88.72%,and 86.23%,respectively;again,CRP,AUC was 0.743,and the predictive sensitivity,specificity,and accuracy were73.53%,87.97%,and 85.03%,respectively;the last was NE,with AUC of 0.715,predicting the sensitivity,specificity and accuracy were 61.76%,86.47%and 79.64%,respectively.The predictive performance of the combined detection of the three indicators was higher than that of the single detection of the three indicators(P<0.05),but the predictive performance of the single detection of the three indicators was similar(P>0.05).Conclusions(1)Peripheral blood PCT and CRP increased,while NE decreased in patients with agranulocytosis infection after chemotherapy for malignant tumor.With the development of effective anti-infective therapy,PCT and CRP decreased and NE deficiency improved.(2)PCT,CRP and NE can all predict the infection in the granulocytic stage of malignant tumor after chemotherapy,and PCT has the highest predictive value,while CRP and NE have similar predictive value.(3)Gram-negative bacteria were the main infection in agranuloma after chemotherapy.PCT and CRP can predict the infection types of pathogenic bacteria,and the combined predictive value of the two indexes is higher.(4)PCT,CRP and NE can all be used to predict the prognosis of patients with agranulocytosis infection after malignant tumor chemotherapy,and the combination of the three indicators is more helpful to improve the prediction accuracy. |
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