Can procalcitonin distinguish infectious fever from tumor‐related fever in non‐neutropenic cancer patients?

Abstract

BACKGROUND: Procalcitonin (PCT) has been proposed as a marker of infection and was studied in neutropenic patients. This study investigated its role in non‐neutropenic febrile cancer patients (NNCPs). METHODS: Between July 2009 and July 2010, a total of 248 NNCPs with fever were studied. PCT was measured in plasma within 24 hours of fever onset and 4 to 7 days thereafter, using a Kryptor system with a lower limit of quantitation of 0.075 ng/mL. Patients' clinical, microbiological, and radiological data were reviewed to make the diagnosis and were correlated with PCT levels. RESULTS: This study included 30 patients with bloodstream infection (BSI), 60 with localized bacterial infection, 141 with no documented infection, and 8 with tumor‐related fever. Most patients (98%) were inpatients or admitted to the hospital during the study. Patients with BSI had significantly higher PCT levels than did those with documented localized infections (P = .048) and no documented infection (P = .011). PCT levels were significantly higher in septic patients than in those without sepsis (P = .012). Patients with stage IV disease or metastasis had significantly higher baseline PCT levels than did those with early stages of cancer (P < .05). PCT levels dropped significantly in patients with bacterial infections in response to antibiotics (P < .0001). CONCLUSIONS: Baseline PCT levels are predictive of BSI and sepsis in NNCPs. They may be predictors of metastasis and advanced cancer. Subsequent decrease in PCT levels in response to antibiotics is suggestive of bacterial infection. Larger trials are needed to confirm the results of this pilot study. Cancer 2012. © 2012 American Cancer Society.

Procalcitonin as diagnostic marker of infection in solid tumors patients with fever

“…In this population the onset of an unknown origin fever could lead a diagnostic issue. Therefore Shomali et al explored ProCT role as a bio-marker to differentiate an infectious origin fever and a non-infectious origin fever in non-neutropenic patients with both solid tumors and hematological malignancies12. Our study aimed to defining the potential role of ProCT, used as an earlier diagnostics biomarker1314, in a cohort of patients with fever and with diagnosed solid tumor followed in our oncologic ceter consecutively.…”

Procalcitonin as a biomarker for infection-related mortality in cancer patients

“…PCT has high accuracy in establishing or refusing a sepsis diagnosis when value PCT is below the level of 0.5 mg/l or over the level of 2.0 mg/l [30 && ]. One recent study in cancer patients showed that PCT was able to differentiate tumor-and infection-induced fever [33]. Thus, the PCT is not only a more sensitive biomarker, but also a more specific marker (with high-negative predictive value for infection) compared with CRP and ESR [31].…”

Procalcitonina como biomarcador diagnóstico de sepsis en el niño con cáncer, neutropenia y fiebre: revisión de la literatura

“…En este trabajo, se encontró que la concentración en suero de la procalcitonina en sujetos con una infección sistémica bacteriana (1,06 ng/mL; IC 95%, 0,075-81,95) era mayor que en los sujetos en quienes se documentó fiebre por actividad tumoral (0,67 ng/mL; IC 95%, 0,11-4,14; p= 0,033). 27 Otra estrategia que puede ser utilizada para evaluar la procalcitonina como marcador diagnóstico de sepsis en el niño con cáncer, NF, es la de cuantificar los niveles séricos de la procalcitonina en cuatro momentos que permiten establecer un patrón diferencial en su comportamiento: Grupo A) niños con diagnóstico reciente de cáncer previo al uso de quimioterapia; Grupo C) niños con neutropenia y fiebre; y Grupo D) al momento del egreso hospitalario. Esto indica que los niveles de procalcitonina son mayores en el sujeto con proceso infeccioso activo que en los individuos con actividad tumoral, y estos, a su vez, que los sujetos que se egresan del hospital.…”