Abstract
Purpose To calculate the diagnostic value of C-reactive protein (CRP) and serum procalcitonin (PCT) levels for the pathologic presence of microbes in the bloodstream of patients with malignancy, in comparison with blood culture. Methodology. Blood culture (by reference method) and assay results of PCT and CRP of febrile patients, with clinical suspicion to blood infections, were collected. Statistical aspects of PCT and CRP tests were evaluated. Results Data from 255 cases were gathered. The area under the curve for differentiating bacteremia from nonbacteremia for PCT (0.741) was superior to that of CRP (0.612). Amongst the different cutoffs of PCT and CRP, the cutoff of ≥1.17 ng/ml and >47 mg/l had the sensitivity of 75 and 58.3%, the best NPV of 91.5% and 81.3%, and the best specificity of 79.9% and 72.8%, respectively. Discussion. Despite statistically nonsignificant results, PCT seems to be a superior indicator to CRP for rejecting the presence of microorganism in bloodstream. For PCT, the cutoff value of 1.17 ng/ml (bacteremia from nonbacteremia) had the highest NPV value of 91.5% in malignant patients, suspicion of sepsis.
Highlights
Infections are an important cause of morbidity and mortality amongst oncology patients, and neutropenia is recognized as the most important risk factor, which its severity and duration are associated with a higher rate of infection [1]. e classic symptoms of infection are fever and leukocytosis
We evaluated the value of C-reactive protein (CRP) marker and PCT in differentiating bacteremia from nonbacteremia as well as differentiating bacteremia from contamination in peripheral blood cultures. e results showed that the mean value of the PCT level was significantly higher in the bacteremia than the nonbacteremia group, and this value was significantly higher in the bacteremia than the contamination group
In comparison between bacteremia and nonbacteremia, the AUC of PCT was higher than CRP, and the P value of PCT as a single test was statistically significant, but it is not for CRP
Summary
Infections are an important cause of morbidity and mortality amongst oncology patients, and neutropenia is recognized as the most important risk factor, which its severity and duration are associated with a higher rate of infection [1]. e classic symptoms of infection are fever and leukocytosis. Temperature greater than 38°C for more than an hour in a patient whose absolute neutrophil count (ANC) of peripheral blood is less than 500 cells per cubic millimeters or below is called neutropenia with fever. In these patients, since the immune system is suppressed by extensive chemical therapies, fever can be considered as the only positive finding as a probable infection that should be further investigated [2]. But not a sensitive marker, and is influenced by noninfectious factors such as antipyretics It is a criterion for sepsis [3, 4]. Leukocytosis has limitations in the diagnosis of infection and sepsis [5]
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Schedule a callMore From: The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale
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