Cancer Res Treat.  2011 Sep;43(3):176-180.

The Usefulness of Procalcitonin and C-Reactive Protein as Early Diagnostic Markers of Bacteremia in Cancer Patients with Febrile Neutropenia

• Kim DY
• Lee YS
• Ahn S
• Chun YH
• Lim KS

Abstract

PURPOSE
Procalcitonin (PCT) and C-reactive protein (CRP) are well known inflammatory markers. This study was designed to determine whether PCT and CRP are useful as early diagnostic markers for bacteremia in cancer patients with febrile neutropenia (FN) in the emergency department (ED).
MATERIALS AND METHODS
In this retrospective study, 286 episodes of FN in the ED were consecutively included between June 2009 and August 2010. From medical records, clinical characteristics including PCT and CRP were extracted and analyzed.
RESULTS
Bacteremia was identified in 38 (13.3%) of the 286 episodes. The median values of PCT (2.8 ng/mL vs. 0.0 ng/mL, p=0.000) and CRP (15.9 mg/dL vs. 5.6 mg/dL, p=0.002) were significantly higher in the group with bacteremia compared to the group without bacteremia. In univariate analysis, elevated PCT (>0.5 ng/mL) and CRP (>10 mg/dL) as well as older age, hypotension, tachycardia, tachypnea, and high body temperature were significantly associated with bacteremia. On multivariate analysis, elevated PCT (>0.5 ng/mL) (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4 to 9.2; p<0.01) and tachypnea (OR, 3.4; 95% CI, 1.4 to 8.5; p<0.01) were independent early diagnostic markers for bacteremia in FN patients. The area under the curve of PCT was 74.8% (95% CI, 65.1 to 84.6%) and that of CRP was 65.5% (95% CI, 54.8 to 76.1%). With a PCT cut-off value of 0.5 ng/mL, sensitivity and specificity were 60.5% and 82.3%, respectively, while the sensitivity and specificity were 57.6% and 67.3%, respectively, with a CRP cutoff of 10 mg/dL.
CONCLUSION
These findings suggest that PCT is a useful early diagnostic marker for the detection of bacteremia in FN at the ED and has better diagnostic value than CRP.

Keyword

Procalcitonin; C-reactive protein; Neutropenia; Biomarkers; Bacteremia

MeSH Terms

Bacteremia
Biomarkers
Body Temperature
C-Reactive Protein
Calcitonin
Emergencies
Humans
Hypotension
Medical Records
Multivariate Analysis
Neutropenia
Protein Precursors
Retrospective Studies
Sensitivity and Specificity
Tachycardia
Tachypnea
C-Reactive Protein
Calcitonin
Protein Precursors

Figure

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  Fig. 1 Receiver operating characteristic (ROC) curves of procalcitonin (PCT) and C-reactive protein (CRP). The areas under the ROC curves of PCT and CRP were 74.8% and 65.5%, respectively. CI, confidence interval.

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