Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia

• Published in: Cancer Vol. 100; no. 11; pp. 2462 - 2469
• Main Authors: Jimeno, Antonio, García‐Velasco, Adelaida, del Val, Olga, González‐Billalabeitia, Enrique, Hernando, Susana, Hernández, Rosario, Sánchez‐Muñoz, Alfonso, López‐Martín, Ana, Durán, Ignacio, Robles, Luis, Cortés‐Funes, Hernán, Paz‐Ares, Luis
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.06.2004; Wiley-Liss
• Subjects: Adult; Aged; Biological and medical sciences; Biomarkers - blood; Calcitonin - blood; Calcitonin Gene-Related Peptide; clinical evaluation; Diagnosis, Differential; febrile neutropenia; Female; Fever - blood; Hematologic and hematopoietic diseases; Humans; Male; Medical sciences; Middle Aged; Neoplasms - blood; Neutropenia - blood; Other diseases. Hematologic involvement in other diseases; procalcitonin; Prognosis; Prospective Studies; Protein Precursors - blood; risk assessment; Risk Factors; Sensitivity and Specificity; solid tumors; Treatment Outcome; Human; Evaluation; Solid tumor; risk assessment; Prognosis; Leukopenia; Procalcitonin; Risk; Hemopathy; Tumoral marker; febrile neutropenia; clinical evaluation; Fever; solid tumors; Risk factor; Diagnosis; Neutropenia
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.20275

BACKGROUND Cancer patients with fever and neutropenia currently are assessed on clinical grounds only. The current study prospectively evaluated the efficacy of baseline procalcitonin (PCT) in the detection of bacteremia and in the prediction of outcome in patients with solid tumors and febrile neutropenia. METHODS PCT levels were determined at baseline and every 48 hours in 104 patients undergoing chemotherapy who developed fever (axillary temperature > 38 °C on 2 occasions or > 38.3 °C in a single record) and neutropenia (absolute neutrophil count < 500 cells/μL). RESULTS The median baseline PCT values were significantly higher in patients who had microbiologically documented infections (1.24 ng/mL) compared with patients who had clinically documented infections (0.27 ng/mL) or fever of unknown origin (0.21 ng/mL; P < 0.01). Accordingly, a PCT cut‐off value of 0.5 ng/mL was reached more frequently in patients who had microbiologically documented infections compared with patients who had clinically documented infections or fever of unknown origin (66.7% vs. 13.4%, respectively; P < 0.001). Furthermore, this threshold also was associated with an increased likelihood of treatment failure (70.0% vs. 14.9%; P < 0.001). All 4 septic patients and all 5 patients who ultimately died presented PCT values 5‐fold to 10‐fold greater than the median values. Clinical evaluation in combination with baseline PCT assessment appeared to improve clinical risk evaluation alone. CONCLUSIONS Baseline PCT levels were higher in patients who had febrile neutropenia with bacteremia compared with patients who had clinical infections or fever of unknown origin. PCT helped to identify patients who had microbiologic infections and patients who were at high risk of treatment failure, and PCT may constitute a complementary tool in the initial assessment of such patients. Cancer 2004. © 2004 American Cancer Society. Baseline procalcitonin levels are higher in febrile neutropenic patients who have bacteremia compared with patients who have a clinical infection or fever of unknown origin. Combined clinical and procalcitonin assessment may improve clinical risk evaluation alone.