Abstract
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.
Highlights
Patients with lung cancer are susceptible to bacterial infections owing to their compromised immune system [1], leading to high morbidity and mortality [2, 3]
We first confirmed whether white blood cell (WBC) and NEU levels and neutrophil-to-lymphocyte ratio (NLR) could be used in the diagnosis of bacterial infections for nonneutropenic lung cancer patients (NNLCPs) as shown in the bacteria-infected and tumor fever (TF) groups (Figure S1)
Our data demonstrated that PCT, C-reactive protein (CRP), WBC, and NEU levels and NLR were predictive of infectious fever in NNLCPs
Summary
Patients with lung cancer are susceptible to bacterial infections owing to their compromised immune system [1], leading to high morbidity and mortality [2, 3]. Us, a differential diagnosis of fever at the initial stage of therapy is important [8] In such cases, bacterial infections in NNLCPs should be identified to provide appropriate and effective treatment. Most bacterial infections can be diagnosed based on clinical symptoms, inflammatory markers, radiological imaging, and microbiological data [1, 9]. Conventional biomarkers such as white blood cell (WBC) count, neutrophil (NEU) count, erythrocyte sedimentation rate, and clinical signs and symptoms are not sufficiently sensitive and specific to guide treatment decisions for NNLCPs with fever [10,11,12]. 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
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