The effects of pretransplant conditioning, graft-versus-host disease and sepsis on the CRP levels in bone marrow transplantation

To evaluate the diagnostic utility of C-reactive protein (CRP) for the detection of sepsis in bone marrow transplantation, CRP levels were analyzed after pretransplant conditioning and variably combined in septic, focal or viral infections with graft-versus-host disease (GVHD) in 64 bone marrow recipients. The CRP levels after pretransplant conditioning were low. The peak levels of CRP were influenced independently by the type of infection (p = 0.016; septic and viral infections were significantly different) and GvHD (p = 0.003). The area under the receiver-operator characteristic (ROC) curve for peak CRP in sepsis was 0.653 and 0.618 with and without GvHD, respectively, It was concluded that GvHD and the type of infection were independent determinants of the CRP responses. GVHD did not affect the extent of the CRP response. Therefore, although not highly specific for sepsis, CRP remains a useful detector of sepsis in bone marrow transplantation.