Utility of procalcitonin and C-reactive protein as predictors of Gram-negative bacteremia in febrile hematological outpatients

Jabbour, Jean Pierre; Ciotti, Giulia; Maestrini, Giacomo; Brescini, Mattia; Lisi, Chiara; Ielo, Claudia; Pietra, G. La; Luise, Cristina; Riemma, Costantino; Breccia, Massimo; Brunetti, Gregorio Antonio; Carmosino, Ida; Latagliata, Roberto; Morano, Giuseppina; Martelli, Maurizio; Girmenia, Corrado

doi:10.1007/s00520-021-06782-w

Cited by 6 publications

(19 citation statements)

References 27 publications

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“… 36 However, previous studies have suggested that differences of PCT concentrations exist in patients with hematologic malignancies. 24 , 25 , 27 , 28 , 34 , 37 , 38 , 39 Interestingly, our PCT value was similar to another study that assessed this biomarker in CAR‐T therapy recipients. 40 …”

Section: Discussionsupporting

confidence: 83%

“… 31 , 32 , 33 Previously determined PCT thresholds, diagnostic accuracy, and predictive performance have varied by immune status, disease state, patient population, clinical presentation, outcome studied, and test used. 16 , 19 , 20 , 25 , 26 , 27 , 28 , 34 , 35 The cutoff of 0.4 ng/mL determined in our study differs from the 0.25 ng/mL that is commonly used for community‐acquired bacterial pneumonia. 21 Additionally, it is lower than the cutoff value of 1.5 ng/mL that demonstrated utility in diagnosing bacterial infections in patients undergoing hemodialysis.…”

Section: Discussioncontrasting

confidence: 67%

“…18 , 19 , 20 , 21 , 22 , 23 Typically, PCT levels begin rising within 3–4 h of bacterial infection and usually peak between 12 and 36 h. 17 Additionally, serum PCT monitoring has been found to successfully predict infection, particularly bacteremia, in patients with hematological malignancies. 24 , 25 , 26 , 27 , 28 Lastly, longitudinal serum PCT monitoring can facilitate antibiotic discontinuation without compromising patient safety. 29 , 30 …”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21][22][23] Typically, PCT levels begin rising within 3-4 h of bacterial infection and usually peak between 12 and 36 h. 17 Additionally, serum PCT monitoring has been found to successfully predict infection, particularly bacteremia, in patients with hematological malignancies. [24][25][26][27][28] Lastly, longitudinal serum PCT monitoring can facilitate antibiotic discontinuation without compromising patient safety. 29,30 It is unknown whether serum PCT concentration monitoring can differentiate between bacterial infection or CRS when CAR-T therapy recipients present with a constellation of signs and symptoms that represent either complication.…”

Section: Introductionmentioning

confidence: 99%

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Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T‐cell therapy recipients

et al. 2023

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Background It is unknown whether serum procalcitonin (PCT) concentration monitoring can differentiate between bacterial infection or cytokine release syndrome (CRS) when chimeric antigen receptor T‐cell (CAR‐T) recipients present with a constellation of signs and symptoms that may represent both complications. Objective The objective of the study was to assess the utility of serum PCT concentrations as a biomarker of bacterial infection in CAR‐T recipients. Study design This single‐center, retrospective, medical record review evaluated patients prescribed CAR‐T therapy until death or 30 days after infusion. Logistic regression modeling determined the association between elevated serum PCT concentrations within 48 h of fever onset and microbiologically confirmed infection. Secondary outcomes included clinically suspected infection, CAR‐T toxicity rates, and broad‐spectrum antibiotic usage. Predictive performance of PCT was assessed by area under the receiver operating characteristic curve (AUC). Results The 98 included patients were a median age of 63 (IQR: 55–69) years old, 47 (48%) were male, and 87 (89%) were Caucasian. Baseline demographics and clinical characteristics were similar between patients with and without a bacterial infection. Serum PCT >0.4 ng/mL within 48 h of fever was significantly associated with a microbiologically confirmed bacterial infection (OR: 2.75 [95% CI: 1.02–7.39], p = 0.045). Median PCT values in patients with and without confirmed infections were 0.40 ng/mL (IQR: 0.26, 0.74) and 0.26 ng/mL (IQR: 0.13, 0.47), respectively. The AUC for PCT to predict bacterial infection was 0.62 (95% CI 0.48–0.76). All patients experienced CRS of some grade, with no difference in CRS severity based on elevated PCT. Broad‐spectrum antibiotics were used for a median of 45% and 23% of days in those with and without confirmed infection, respectively ( p = 0.075). Conclusion Elevated serum PCT concentrations above 0.4 ng/mL at time of first fever after CAR‐T infusion was significantly associated with confirmed bacterial infection. Furthermore, rigorous, prospective studies should validate our findings and evaluate serial PCT measurements to optimize antimicrobial use after CAR‐T therapy.

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Section: Discussionsupporting

confidence: 83%

Section: Discussioncontrasting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T‐cell therapy recipients

et al. 2023

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“…This study had some limitations. First, PCT levels can vary with infection time, specifically during the first 6 h of infection [ 30 , 31 ]. The ability of PCT to distinguish between infections caused by gram-negative and gram-positive bacteria may have been weakened by the fact that the intervals between the symptoms and sampling times varied.…”

Section: Discussionmentioning

confidence: 99%

Association of Procalcitonin with the Patient’s Infection Characteristics and Prognosis after Hematopoietic Stem Cell Transplantation

Nan

et al. 2022

Disease Markers

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Objective. To study whether procalcitonin (PCT) is an important indicator of infection with or without agranulocytosis and to reveal whether PCT can distinguish between infected sites and affect prognosis after hematopoietic stem cell transplantation (HSCT). Method. In the present study, 682 patients with HSCT were enrolled, and their clinical characteristics were noted. Their blood culture and inflammatory and biochemical indicators were studied. The patients were divided into respective groups according to the degree of agranulocytosis, type of bacterial infection, infected sites, and prognosis. Results. The PCT, CRP, and D-dimer levels were significantly improved in patients with positive blood culture results compared to the case for those with negative blood culture results. The PCT level was the highest in the gram-negative group. The levels of PCT and D-dimer were significantly elevated in patients with infection and agranulocytosis after HSCT compared to those in the nonagranulocytosis cohort. Interestingly, no significant difference in the PCT level was observed among any of the eight foci. Lower PCT levels were associated with higher survival in patients with infection after HSCT. Conclusion. Among patients that underwent HSCT, PCT levels were significantly elevated in those with infection and agranulocytosis, with the levels being specifically high in the gram-negative group. Moreover, lower PCT levels were associated with higher survival in patients with infection after HSCT.

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Pregnancy Outcomes in Patients with Urosepsis and Uncomplicated Urinary Tract Infections- a Retrospective Study

Radu,

Vicoveanu,

Cărăuleanu

et al. 2023

Preprint

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(1) Background: Urinary tract infections (UTIs) are an important cause of perinatal and maternal morbidity and mortality. The aim of this study was to describe and compare the main pregnancy outcomes among pregnant patients with complicated and uncomplicated UTIs; (2) Methods: This retrospective study included 183 pregnant patients who were evaluated for uncomplicated UTIs and urosepsis in the Urology Department of ‘C.I. Parhon’ University Hospital, and who were followed up at a tertiary maternity hospital- ‘Cuza-voda’ from Romania between January 2014 and October 2023. The control group (183 patients) was randomly selected from the patient’s cohort who gave birth in the same time frame at the maternity hospital without urinary pathology. Clinical and paraclinical data was examined. Descriptive statistics and a conditional logistic regression model were used to analyze our data. (3) Results: Our results indicated that patients with urosepsis had increased risk of premature rupture of membranes (aOR: 5.59, 95%CI: 2.02- 15.40, p&lt; 0.001) and preterm birth (aOR: 2.47, 95%CI: 1.15- 5.33, p= 0.02). We could not demonstrate a statistically significant association between intrauterine growth restriction and preeclampsia with the studied urological pathologies. (4) Conclusions: Careful UTIs screening during pregnancy is needed for preventing maternal-fetal complications.

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Utility of procalcitonin and C-reactive protein as predictors of Gram-negative bacteremia in febrile hematological outpatients

Cited by 6 publications

References 27 publications

Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T‐cell therapy recipients

Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T‐cell therapy recipients

Association of Procalcitonin with the Patient’s Infection Characteristics and Prognosis after Hematopoietic Stem Cell Transplantation

Pregnancy Outcomes in Patients with Urosepsis and Uncomplicated Urinary Tract Infections- a Retrospective Study

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