Evaluation of C-Reactive Protein and Procalcitonin as a Mortality Indicator in Febrile Neutropenic Patients

Abstract

Introduction: Febrile neutropenia (FN) develops as a side effect of chemotherapeutics in cancer patients. It causes complications, increased cost, and mortality. Microbiological agents can be detected in 30-50% of FN. Therefore, specific, highly effective, and rapid markers that can indicate infection are needed. Various biomarkers are under investigation and are still in use today. In this study, it was aimed to evaluate their effectiveness in early detection of infection and mortality by comparing quantitative C-reactive protein (CRP) and procalcitonin values at the beginning of FN and during treatment. Methodology This research is a retrospective, case-control study. The study included 572 FN patients who were followed up in the Hematology Clinic, Bone Marrow Transplantation Unit and Medical Oncology Clinic between 3 September 2018 and 25 May 2022. 748 FN attacks developed in these patients. The hospital information management system was analysed, and the data of the patients were recorded in the pre-prepared form. Data were analysed using ‘The Package for Social Sciences 26.0’ statistical program. Results: 49.1% of FN cases were female and 50.9% male. Hematological malignancy was detected in 60.8% of the patients. Mortality developed in 118 (20.6%) patients. The rate of bacteremia in FN attacks was 36.5%. The most common causative microorganism was Escherichia coli. Pseudomonas aeruginosa and Acinetobacter baumannii were more common in patients with mortality. CRP and procalcitonin values in the first five days of treatment were higher in patients with bacteremia and mortality. Prolonged neutropenia and bloodstream infection were found to be risk factors for mortality. Conclusion: It has been observed that CRP and procalcitonin values can be used both prognostically and diagnostically. It was found that resistant Gram-negative bacteria growth was higher in blood cultures of patients with mortality. More studies are needed to develop new treatment algorithms.