Non-infectious causes of elevated procalcitonin and C-reactive protein serum levels in pediatric patients with hematologic and oncologic disorders

Abstract

PCT and CRP are of limited value as diagnostic markers of sepsis during T-cell-directed immunomodulatory treatment, granulocyte support, or acute GvHD.

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

“…Además, la procalcitonina presenta baja sensibilidad y especificidad para diagnosticar enfermedad micótica invasiva (particularmente, aspergillosis). 25,26 Shomali et al en 2012, establecieron, mediante un estudio comparativo, el papel que juega la procalcitonina como marcador que puede diferenciar la fiebre consecuencia de un proceso infeccioso de la ocasionada por la actividad tumoral en los pacientes no neutropénicos, tomando como punto de corte 0,075 ng/mL. 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).…”

Biomarkers in Pediatric Sepsis

“…Although a positive CRP will only increase probability of infection by 11%, a negative CRP decreases probability of infection 33% [16]. All neonatal patients, as well as pediatric patients with liver failure or undergoing steroid treatment, have decreased CRP levels in response to infection due to decreased cytokine activation [14,15].…”

“…CRP is a marker of inflammation, and not of infection. As such, it may be elevated in many other conditions such as viral infection, malignancy, trauma, post-operative, burn injury, tissue necrosis, immunologically-mediated inflammatory diseases, crystal-induced inflammatory diseases, and even obesity [13,14]. CRP is 87-97% specific and 15-29% sensitive in diagnosing neonatal sepsis and particularly less useful in preterm infants [15].…”

“…In cases of sepsis, however, PCT has an extrathyroidal origin and is produced in response to endotoxin (gram negative sepsis) and/or cytokines involved in the sepsis cascade [14,22]. PCT has been found to be an indicator of bacterial and fungal infection in cases of pneumonia [23], acute respiratory distress syndrome [24], systemic inflammatory response syndrome [16], sepsis [13], shock [25], post-operative and trauma patients [22], and oncologic conditions [14]. Not only has PCT been found to be a marker of infection in general, but has also been shown to increase as disease severity worsens, and although the mode of action during times of sepsis is unclear, PCT has been implicated in mediating the inflammatory process [8].…”

“…PCT is a precursor protein of calcitonin which is produced by the thyroid C cells during normal physiologic conditions. In cases of sepsis, however, PCT has an extrathyroidal origin and is produced in response to endotoxin (gram negative sepsis) and/or cytokines involved in the sepsis cascade [14,22]. PCT has been found to be an indicator of bacterial and fungal infection in cases of pneumonia [23], acute respiratory distress syndrome [24], systemic inflammatory response syndrome [16], sepsis [13], shock [25], post-operative and trauma patients [22], and oncologic conditions [14].…”