Research Article Soluble CD14 as a Diagnostic and Prognostic Biomarker in Hematological Patients with Febrile Neutropenia Sini Korpelainen, 1 Carina Intke, 2 Sari Hämäläinen, 2 Esa Jantunen, 2 Auni Juutilainen, 3 and Kari Pulkki 1 1 University of Eastern Finland and Eastern Finland Laboratory Centre, Kuopio, Finland 2 Kuopio University Hospital, Kuopio, Finland 3 University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland Correspondence should be addressed to Kari Pulkki; kari.pulkki@uef.fi Received 10 May 2017; Accepted 28 June 2017; Published 6 August 2017 Academic Editor: Silvia Angeletti Copyright © 2017 Sini Korpelainen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. Elevated levels of a cell surface glycoprotein, soluble cluster of differentiation 14 (sCD14), have been observed in patients with sepsis. Only scarce data are available on sCD14 in hematological patients with chemotherapy-induced febrile neutropenia. The study aim was to investigate sCD14 as an early biomarker in febrile neutropenia after intensive chemotherapy to detect a rapidly deteriorating clinical course early enough to avoid serious infectious complications. Patients and Methods. This prospective study included 87 adult hematological patients at the start of febrile neutropenia after intensive chemotherapy for acute myeloid leukemia or after autologous stem cell transplantation. The study endpoints were septic shock, severe sepsis, and positive blood culture findings. sCD14 was analyzed from day 0 to day 2, and its prognostic capacity was compared to that of C-reactive protein and procalcitonin. Results. Plasma level of sCD14 predicted the development of septic shock on day 1 (p =0 001) and day 2 but not the development of severe sepsis or blood culture positivity in hematological patients with chemotherapy-induced febrile neutropenia. Conclusions. Soluble CD14 did not predict an overall complicated course at the early stages of febrile neutropenia. However, it was helpful in predicting the progression of the clinical course of neutropenic fever to septic shock. 1. Introduction Patients receiving intensive chemotherapy for hematological malignancies frequently develop febrile neutropenia. They are at high risk of sepsis and septic complications. The onset of septic infection can be insidious, and the outcome may be fatal. An early diagnosis of sepsis is crucial in the prevention of serious complications, and it still remains a challenge for clinicians because of the lack of appropriate diagnostic methods [1]. By definition, demonstrating bacteremia requires blood cultures, but they are time-consuming and often give false-negative results or get microbial contamina- tion [2]. C-reactive protein (CRP) is widely used as an indica- tor of infection, but it reacts too slowly for prognostic use at the early stages of sepsis [3]. Procalcitonin (PCT) has been studied in neutropenic patients and found to be useful in dis- tinguishing sepsis from noninfectious causes of fever [4, 5]. One of the new biomarkers for sepsis is soluble CD14 [6], but there are limited data on its predictive value in febrile neutropenia of adult patients with hematological malignancies. Cluster of differentiation 14 (CD14) is a cell surface glycoprotein expressed mainly in innate immune response cells such as monocytes, macrophages, neutrophils, and B cells. CD14 recognizes ligands at the cell surface of both gram-negative and gram-positive bacteria and binds to them. It serves as a high-affinity receptor for lipopolysaccharide (LPS) and LPS-binding protein (LBS) complexes. The CD14-LPS-LBS-complex activates the Toll-like receptor 4- specific proinflammatory signalling cascade against infec- tious agents. The complex including CD14 is released from the cell membrane into the circulation creating soluble CD14 (sCD14) [7–9]. Soluble CD14 can also be directly released by hepatocytes [10]. Circulating plasma proteases Hindawi Disease Markers Volume 2017, Article ID 9805609, 8 pages https://doi.org/10.1155/2017/9805609