Procalcitonin Is Not Useful to Discriminate Between Infectious and Noninfectious CRP Elevation in Patients with Non–Small Cell Lung Cancer

Scheinpflug, Katrin; Schalk, Enrico; Grabert, Elske; Achenbach, H. Jost

doi:10.1017/ice.2015.134

Cited by 7 publications

(10 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The application of PCT in patients with lung cancer remains controversial. In a previous study, the researchers compared serum PCT levels in infected and non-infected lung cancer patients and found no difference between the two groups 12 . The study also found no difference in CRP levels between the two groups, while there was a strong correlation between PCT and CRP (r = 0.80).…”

Section: Discussionmentioning

confidence: 98%

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

Wang

Huo

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Acute Radiation Pneumonitis (ARP) is one of the most common dose-limiting toxicities of thoracic radiotherapy. The accurate diagnosis of ARP remains a challenge because of the lack of a rapid biomarker capable of differentiating ARP from bacterial pneumo (BP). The aim of this study was to investigate the potential usefulness of procalcitonin (PCT) in the differential diagnosis of ARP and BP. Lung cancer patients who had undergone thoracic radiotherapy within 6 months and were admitted to hospital for ARP or BP were retrospectively analyzed. The serum levels of PCT, C-reactive protein (CRP) and white blood cells (WBC) were compared between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of PCT, CRP and WBC in the differential diagnosis of ARP and BP and determine the best cutoff values. One hundred eighteen patients were included. Among them, seventy-seven patients were diagnosed with ARP, and 41 patients were diagnosed with BP. The PCT concentrations for patients diagnosed with ARP group were significantly lower than those in the BP group (P < 0.001). There were no differences in CRP and WBC between the two groups. The areas under the ROC curves (AUC) for PCT, CRP and WBC were 0.745, 0.589 and 0.578, respectively. The best cutoff values of PCT, CRP and WBC were 0.47 μg/L, 54.5 mg/L and 9.9 × 10 9 /L, respectively. Low serum PCT levels are associated with ARP. PCT is a useful biomarker to distinguish ARP from BP. Radiotherapy has been widely used for the curative and palliative treatment of lung cancer. Radiation-induced lung injury (RILI) is the most common dose-limiting toxicity of thoracic radiotherapy 1. RILI includes acute radiation pneumonitis (ARP) and pulmonary fibrosis. ARP often occurs about 1 to several months after radiotherapy. Commonly, ARP is relatively mild with patients, exhibiting no obvious symptoms except for imaging abnormalities. However, ARP can be a very serious event, especially after large volume radiotherapy. The incidence of grade 3-5 ARP can reach about 20% according to a recent study 2. When symptoms are more severe, patients cannot be managed as outpatients and require hospitalization. Continued progression of symptomatic ARP can cause respiratory failure and even death. Early and timely intervention can prevent the progression of ARP, improve patient symptoms, and potentially reduce post-radiation pulmonary fibrosis. However, accurate diagnosis of ARP remains difficult. The most important issue for radiation oncologists is to differentiate them from the bacterial pneumonia (BP) which are common in lung cancer patients 3. ARP and BP share many of the same symptoms such as cough and fever and both can be identified by changes in imaging. ARP can usually be identified by the positional relationship between the shapes of the radiation field and the

show abstract

Section: Discussionmentioning

confidence: 98%

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

Wang

Huo

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…CRP and PCT are often used for the diagnosis of infectious diseases in clinical practice, their usefulness remains controversial. For example, the diagnostic accuracy of CRP and PCT for diagnosing bacterial infection as a cause of fever in one previous study [ 16 ] was poor, and another earlier study [ 17 ] found that PCT and CRP were not discriminators between infectious and noninfectious patients with NSCLC. However, some studies [ 18 – 20 ] have shown that PCT concentration is a better predictor than CRP concentration in the diagnosis of sepsis, and the results of our study also indicate that PCT is more useful than CRP to discriminate between infectious fever and TF.…”

Section: Discussionmentioning

confidence: 99%

Role of C-reactive protein and procalcitonin in discriminating between infectious fever and tumor fever in non-neutropenic lung cancer patients

Zhao

et al. 2018

Medicine

View full text Add to dashboard Cite

This study assessed whether C-reactive protein (CRP) and procalcitonin (PCT) levels can discriminate between infectious fever and tumor fever (TF) in non-neutropenic patients with nonsmall cell lung cancer (NSCLC).This retrospective clinical study included 96 adults with NSCLC who were admitted to the Third Hospital of Hebei Medical University between July 2015 and July 2017. Febrile, non-neutropenic patients were enrolled. CRP and PCT levels, neutrophil count, and antimicrobial response were evaluated.This study included 26 patients with TF, 49 with localized bacterial infection (LBI), and 21 with bloodstream infection (BSI). CRP levels in BSI were significantly higher than in TF (P < .05) and LBI (P < .05). No statistically significant difference was found between patients with TF and LBI (P > .05). PCT levels were significantly higher in BSI and LBI than in TF (P < .05). CRP and PCT levels in patients with stage IV disease were significantly higher than in those with stage II to III disease (P < .05). CRP and PCT levels declined significantly in patients with BSI who were responding to antimicrobials (P < .05).Compared with CRP levels, PCT levels can discriminate between TF and infectious fever more accurately. PCT and CRP levels may predict different stages of lung cancer.

show abstract

“…However, some reports have indicated that the usefulness of these markers in the diagnosis of infectious diseases in clinical practice is disputable. One study retrospectively evaluated the value of PCT level for infectious fever and TF in febrile episodes in patients with cancer [55]. Although PCT level in the former group appeared to be higher than that in the latter group, this difference was not statistically confirmed [56].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Procalcitonin, Neutrophil-to-Lymphocyte Ratio, and C-Reactive Protein in Detection of Bacterial Infections and Prediction of Outcome in Nonneutropenic Febrile Patients with Lung Malignancy

Ding

Song

et al. 2020

Journal of Oncology

View full text Add to dashboard Cite

Background. Procalcitonin (PCT), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) have emerged as important markers of inflammation, and these markers, especially PCT and CRP, have been studied in patients with neutropenia. This study was designed to evaluate their value in differentiating infectious fever from tumor fever (TF) and to investigate their role in assessing outcomes in nonneutropenic lung cancer patients (NNLCPs). Methods. This retrospective clinical study included 588 febrile NNLCPs between January 2019 and December 2019. The levels of PCT, CRP, and conventional inflammatory markers, including white blood cells (WBC) and neutrophils (NEU), were measured. NLR was defined as the ratio of the absolute neutrophil count to the absolute lymphocyte count. Patients’ clinical and bacteriological data were recorded. Results. This study included 311 NNLCPs with bacterial infections and 277 with TF. Inflammatory markers such as PCT, CRP, WBC, and NEU levels and NLR were significantly higher in patients with bacterial infections than in those with TF (p < 0.0001). However, PCT level was the best predictor of bacterial infections, with an area under the curve (AUC) of 0.874, followed by CRP level (AUC = 0.855) and NLR (AUC = 0.792) (p < 0.0001). Additionally, PCT level was significantly elevated in patients with bacterial infections with progressive disease after radiotherapy and chemotherapy (p < 0.01). Conclusions. The present study demonstrated the superiority of PCT over CRP and NLR in the diagnosis of febrile patients with bacterial infections. Additionally, PCT can be used to assess the clinical outcomes and cancer progression in NNLCPs.

show abstract

Procalcitonin Is Not Useful to Discriminate Between Infectious and Noninfectious CRP Elevation in Patients with Non–Small Cell Lung Cancer

Cited by 7 publications

References 7 publications

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

Role of C-reactive protein and procalcitonin in discriminating between infectious fever and tumor fever in non-neutropenic lung cancer patients

Diagnostic Accuracy of Procalcitonin, Neutrophil-to-Lymphocyte Ratio, and C-Reactive Protein in Detection of Bacterial Infections and Prediction of Outcome in Nonneutropenic Febrile Patients with Lung Malignancy

Contact Info

Product

Resources

About