Predictive values of serum amyloid-A and CRP for infection in febrile neutropenic cancer patients

Objectives: To evaluate predictive values of serum amyloid A (SAA) and C-reactive protein (CRP) for infection and mortality in patients with febrile neutropenia (FEN).Methods: Daily measurement of serum SAA and CRP levels of patients during antibiotherapy for FEN.Results: Sixty-five FEN episodes of 52 patients were evaluated.Median CRP and SAA levels on 1st day of FEN were 137 mg/L (23-420 mg/L) and 547 mg/L (11-1660 mg/L), respectively.For detection of infection of infection the sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of SAA at a level of >80 mg/L were as 100%, 48% and 100%.Whilethe sensitivity, PPV, and NPV of CRP at a level of >50mg/L were as 86%, 47% and 60%, respectively.Predictive values of initial SAA and CRP levels for infection didn't differ significantly (CRP: p=0.24,SAA: p=0.39).SAA and CRP levels on the last day of FEN course were significant for infection and mortality (for infection: p=0.003 for CRP and p=0.026 for SAA; for mortality: p<0.001 for CRP and p=0.021 for SAA).Both initial and daily SAA and CRP levels correlated with each other positively and statistically significantly (p<0.001).The area under the curve (AUC) on the receiver operating character (ROC) curve for CRP and SAA were 0.72 (p=0.003,95% CI: 0.59-0.86)and 0.68 (p=0.19,95% CI: 0.54-0.82),respectively. Conclusions:Despite low predictive values in decision of initial therapy, these parameters would be helpful in decision of modification and evaluation of response to therapy.