Procalcitonin (PCT) as an adjunct to the Multinational Association of Supportive Care in Cancer (MASCC) risk-index score in cancer patients with febrile neutropenia

Abstract

8120 Background: The majority of cancer patients who present with febrile neutropenia experience uncomplicated and speedy recovery. Nevertheless, the frequency of complications remains unacceptably high, with a reported mortality rate by all major cooperative groups of approximately 10%. Infections are the major cause of morbidity/mortality in cancer patients undergoing chemotherapy. In this setting, there is a critical requirement for the development of strategies, such as the MASCC risk- index, which enables early identification of patients at high risk for serious infective complications, who would benefit from hospitalization and prompt, aggressive antimicrobial therapy. Methods: The objective was to determine the value of combining PCT, a selective, systemic marker of severe bacterial infection, measured in cancer patients on presentation with chemotherapy-induced febrile neutropenia, with the MASCC score, as a strategy to distinguish between patients with serious infection and those with less serious infection, or non-infective causes of pyrexia. Patients, who experienced 78 febrile neutropenic episodes were classified, into groups with low (<0.5 ng/ml) or high (≥0.5 ng/ml) initial circulating levels of PCT and these groups were compared with MASCC scores, neutrophil and monocyte counts Results: Sixty four % of patients (all survived), presented with low-risk MASCC scores and low PCT values. 19.2%, presenting with high-risk MASCC scores and high PCT values, (46.7% of whom died, p <0.0001), was considered to be at extremely high risk. The remaining patients (16.8%) were classified either as low-risk MASCC score/high PCT (all survived) or high-risk MASCC/low PCT (1 died). By using the MASCC score in conjunction with measurement of PCT, it was possible to categorize around 83% of patients into those at low risk and those at extremely high risk for severe infection and death. Conclusions: PCT values measured on presentation with febrile neutropenia, combined with the MASCC score, distinguish patients with severe infection, who are at high risk of death, from those with less severe infection and non-infective causes of pyrexia. No significant financial relationships to disclose.