Diagnostic performance of procalcitonin, presepsin, and C‐reactive protein in patients with hematological malignancies

Ebihara, Yasuhiro; Kobayashi, Kiyoko; Ishida, Akira; Maeda, Tomoya; Takahashi, Naoki; Taji, Yoshitada; Asou, Norio; Ikebuchi, Kenji

doi:10.1002/jcla.22147

Cited by 22 publications

(22 citation statements)

References 20 publications

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“…The focus of our study was the evaluation of the diagnostic validity of these criteria for the diagnosis of sepsis and the prediction of high risk of in-hospital mortality in a multicentric population of hematological cancer patients. We studied the criteria in analogy to the Sepsis-III study focusing on the criteria and their (bedside) validity, rather than on changes of inflammation markers, which has been studied previously by several groups [32, 33].…”

Section: Discussionmentioning

confidence: 99%

Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study

et al. 2019

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Background With Sepsis-3, the increase in sequential organ failure assessment (SOFA) as a clinical score for the identification of patients with sepsis and quickSOFA (qSOFA) for the identification of patients at risk of sepsis outside the intensive care unit (ICU) were introduced in 2016. However, their validity has been questioned, and their applicability in different settings and subgroups, such as hematological cancer patients, remains unclear. We therefore assessed the validity of SOFA, qSOFA, and the systemic inflammatory response syndrome (SIRS) criteria regarding the diagnosis of sepsis and the prediction of in-hospital mortality in a multicenter cohort of hematological cancer patients treated on ICU and non-ICU settings. Methods We retrospectively calculated SIRS, SOFA, and qSOFA scores in our cohort and applied the definition of sepsis as “life-threatening organ dysfunction caused by dysregulated host response to infection” as reference. Discriminatory capacity was assessed using the area under the receiver operating characteristic curve (AUROC). Results Among 450 patients with hematological cancer (median age 58 years, 274 males [61%]), 180 (40%) had sepsis of which 101 (56%) were treated on ICU. For the diagnosis of sepsis, sensitivity was 86%, 64%, and 42% for SIRS, SOFA, and qSOFA, respectively. However, the AUROCs of SOFA and qSOFA indicated better discrimination for sepsis than SIRS (SOFA, 0.69 [95% CI, 0.64–0.73] p < 0.001; qSOFA, 0.67 [95% CI, 0.62–0.71] p < 0.001; SIRS, 0.57 [95% CI, 0.53–0.61] p < 0.001). In-hospital mortality was 40% and 14% in patients with and without sepsis, respectively ( p < 0.001). Regarding patients with sepsis, mortality was similar in patients with positive and negative SIRS scores (39% vs. 40% ( p = 0.899), respectively). For patients with qSOFA ≥ 2, mortality was 49% compared to 33% for those with qSOFA < 2 ( p = 0.056), and for SOFA 56% vs. 11% ( p < 0.001), respectively. SOFA allowed significantly better discrimination for in-hospital mortality (AUROC 0.74 [95% CI, 0.69–0.79] p < 0.001) than qSOFA (AUROC 0.65 [95% CI, 0.60–0.71] p < 0.001) or SIRS (AUROC 0.49 [95% CI, 0.44–0.54] p < 0.001). Conclusions An increase in SOFA score of ≥ 2 had better prognostic accuracy for both diagnosis of sepsis and in-hospital mortality in this setting, and especially on ICU, we observed limited validity of SIRS criteria and qSOFA in identifying hematological patients with sepsis and at high risk of death. Electronic supplementary material The online version of this article (10.1186/s40560-019-0396-y) contains supplementary material, which is available to authorized users. ...

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Section: Discussionmentioning

confidence: 99%

Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study

et al. 2019

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“…Previous studies have yielded various results. Ebihara et al 16 found that PRE-SEP could be of low diagnostic significance in neutropenic patients, and Koizumi et al 6 showed that the cut-off levels for PRE-SEP in gram-negative bacteremia were higher than the cut-off levels at the onset of febrile neutropenia. Maurice et al 17 identified a positive correlation between the severity of sepsis and PRE-SEP levels, and that PRE-SEP was more specific than CRP in identifying sepsis, while Koh et al 18 reported that PRE-SEP was a more sensitive marker of bacterial infection, than PCT, although the ability of PRE-SEP in differentiating septic shock from other conditions was lower than PCT.…”

Section: Discussionmentioning

confidence: 99%

The predictive value of procalcitonin, C-reactive protein, presepsin, and soluble-triggering receptor expressed on myeloid cell levels in bloodstream infections in pediatric patients with febrile neutropenia

Özdemir¹,

Düzenli-Kar²,

Canik³

et al. 2019

Turk J Pediatr

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Ö. The predictive value of procalcitonin, C-reactive protein, presepsin, and soluble-triggering receptor expressed on myeloid cell levels in bloodstream infections in pediatric patients with febrile neutropenia. Turk J Pediatr 2019; 61: 359-367. The present study investigates the predictive value of procalcitonin (PCT), C-reactive protein (CRP), presepsin (PRE-SEP) and soluble-triggering receptor, as expressed on myeloid cells (sTREM-1) levels in bloodstream infections in pediatric patients with febrile neutropenia. A total of 47 episodes of febrile neutropenia that developed in 30 children with malignancy were analyzed in this study, while the control group comprised 27 children who had undergone chemotherapy for malignancy (completed ≥2 years ago) without neutropenia, fever or drug use. Median PCT, CRP, PRE-SEP and sTREM-1 levels on admission were found to be significantly higher in the patient group than in the control group, while in the blood cultures, the microbiological agent was isolated in 13 (27.7%) of the 47 episodes. Median PCT and CRP levels on days 1, 2 and 7 were higher in the blood culture-positive episodes than in the blood culture-negative episodes. There was no significant difference in the PRE-SEP and sTREM-1 levels on days 1, 2 and 7 between the blood culture-positive and blood culture-negative episodes. The results of the study suggest that PRE-SEP and sTREM-1 are at measurable levels upon admission in children with febrile neutropenia, but that these markers may not be appropriate for the predicting of bloodstream infections, although CRP and PCT levels within the first 24 hours may serve as a guide for clinicians.

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“…It was shown that moderately elevated PCT (1–2.5 ng/mL) could be found in CAP with positive blood culture for Streptococcus pneumoniae mainly in bacterial superinfection after an initial viral episode, possibly reflecting transitory immune impairment ( 33 ). Further, PCT has been shown to strongly correlate with sepsis and septic shock in neutropenic ( 35 , 36 ) and immune-competent patients ( 32 , 37 ). PCT is particularly good in differentiating bacterial from viral meningitis in children ( 38 ) and seems to be useful to rule-in pyelonephritis, but studies on urinary tract infections display a high heterogeneity, which is why PCT cannot be recommended for antibiotic management of urinary tract infections at this point.…”

Section: Procalcitoninmentioning

confidence: 99%

Procalcitonin for Diagnostics and Treatment Decisions in Pediatric Lower Respiratory Tract Infections

et al. 2017

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Mortality and morbidity remain high in pediatric lower respiratory tract infections (LRTIs) despite progress in research and implementation of global diagnostic and treatment strategies in the last decade. Still, 120 million annual episodes of pneumonia affect children younger than 5 years each year leading to 1.3 million fatalities with the major burden of disease carried by low- and middle-income countries (95%). The definition of pneumonia is still challenging. Traditional diagnostic measures (i.e., chest radiographs, C-reactive protein) are unable to distinguish viral and from bacterial etiology. As a result, common antibiotic overuse contributes to growing antibiotic resistance. We present an overview of current evidence from observational and randomized controlled trials on a procalcitonin (PCT)-based diagnosis of pediatric LRTIs and discuss the need for an adequate PCT threshold for antibiotic treatment decision-making.

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Diagnostic performance of procalcitonin, presepsin, and C‐reactive protein in patients with hematological malignancies

Abstract: We conclude that PCT might provide additional information and could be used in combination with other biomarkers to detect infections in patients with hematological malignancies.

Cited by 22 publications

References 20 publications

Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study

Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study

The predictive value of procalcitonin, C-reactive protein, presepsin, and soluble-triggering receptor expressed on myeloid cell levels in bloodstream infections in pediatric patients with febrile neutropenia

Procalcitonin for Diagnostics and Treatment Decisions in Pediatric Lower Respiratory Tract Infections

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