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Published in: BMC Infectious Diseases 1/2007

Open Access 01-12-2007 | Research article

Procalcitonin (PCT) and C-reactive Protein (CRP) as severe systemic infection markers in febrile neutropenic adults

Authors: Karin SR Massaro, Silvia F Costa, Claudio Leone, Dalton AF Chamone

Published in: BMC Infectious Diseases | Issue 1/2007

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Abstract

Background

Procalcitonin (PCT) is an inflammatory marker that has been used as indicator of severe bacterial infection. We evaluated the concentrations of PCT as a marker for systemic infection compared to C-reactive protein (CRP) in patients neutropenic febrile.

Methods

52 adult patients were enrolled in the study. Blood sample was collected in order to determine the serum concentrations of PCT, CRP and other hematological parameters at the onset of fever. The patients were divided into 2 groups, one with severe infection (n = 26) and the other in which the patients did not present such an infection (n = 26). Then PCT and CRP concentrations at the fever onset were compared between groups using non parametric statistical tests, ROC curve, sensitivity, specificity, likelihood ratio, and Spearman's correlation coefficient.

Results

The mean of PCT was significantly higher in the group with severe infection (6.7 ng/mL versus 0.6 ng/mL – p = 0.0075) comparing with CRP. Serum concentrations of 0.245 ng/mL of PCT displayed 100% de sensitivity and 69.2% specificity. PCT concentrations of 2,145 ng/mL presented a likelihood ratio of 13, which was not observed for any concentration of CRP.

Conclusion

PCT seems to be an useful marker for the diagnosis of systemic infection in febrile neutropenic patients, probably better than CRP.
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Literature
1.
go back to reference Hughes WT, Armstrong D, Bodey GP, Bow EJ, Calandra T, Feld R, Pizzo PA, Rolston KVI, Shenep JL, Young LS: Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002, 34: 730-51. 10.1086/339215.CrossRefPubMed Hughes WT, Armstrong D, Bodey GP, Bow EJ, Calandra T, Feld R, Pizzo PA, Rolston KVI, Shenep JL, Young LS: Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002, 34: 730-51. 10.1086/339215.CrossRefPubMed
2.
go back to reference Hansson LO, Lindquist L: C-reactive protein: its role in the diagnosis and follow-up of infectious diseases. Curr Opin Infect Dis. 1997, 10: 196-201. 10.1097/00001432-199706000-00007.CrossRef Hansson LO, Lindquist L: C-reactive protein: its role in the diagnosis and follow-up of infectious diseases. Curr Opin Infect Dis. 1997, 10: 196-201. 10.1097/00001432-199706000-00007.CrossRef
3.
go back to reference Heney D, Lewis IJ, Evans SW, Banks R, Bailey CC, Whicher JT: Interleukin-6 and its relationship to C-reactive protein and fever in children with febrile neutropenia. J Infect Dis. 1992, 165: 886-890.CrossRefPubMed Heney D, Lewis IJ, Evans SW, Banks R, Bailey CC, Whicher JT: Interleukin-6 and its relationship to C-reactive protein and fever in children with febrile neutropenia. J Infect Dis. 1992, 165: 886-890.CrossRefPubMed
4.
go back to reference Katz JA, Mustafa MM, Bash RO, Cash JV, Buchanan GR: Value of C-reactive protein determination in the initial diagnostic evaluation of the febrile, neutropenic child with cancer. Pediatr Infect Dis J. 1992, 11: 708-712.CrossRefPubMed Katz JA, Mustafa MM, Bash RO, Cash JV, Buchanan GR: Value of C-reactive protein determination in the initial diagnostic evaluation of the febrile, neutropenic child with cancer. Pediatr Infect Dis J. 1992, 11: 708-712.CrossRefPubMed
5.
go back to reference Engel A, Mack E, Kern P, Kern WV: An analysis of interleukin-8, interleukin-6 and C-reactive protein serum concentrations to predict fever, gram-negative bacteraemia and complicated infection in neutropenic cancer patients. Infection. 1998, 26: 213-221.CrossRefPubMed Engel A, Mack E, Kern P, Kern WV: An analysis of interleukin-8, interleukin-6 and C-reactive protein serum concentrations to predict fever, gram-negative bacteraemia and complicated infection in neutropenic cancer patients. Infection. 1998, 26: 213-221.CrossRefPubMed
6.
go back to reference Lehrnbecher T, Venzon D, de Haas M, Chanock SJ, Kuehl J: Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein, soluble Fc gamma receptor type III, and mannose-binding protein in febrile children with cancer and neutropenia. Clin Infect Dis. 1999, 29: 414-419.CrossRefPubMed Lehrnbecher T, Venzon D, de Haas M, Chanock SJ, Kuehl J: Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein, soluble Fc gamma receptor type III, and mannose-binding protein in febrile children with cancer and neutropenia. Clin Infect Dis. 1999, 29: 414-419.CrossRefPubMed
7.
go back to reference Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, Anargyrou K, Katsilambros N, Giamarellou H: Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia. Clin Infect Dis. 2001, 32: 1718-1728. 10.1086/320744.CrossRefPubMed Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, Anargyrou K, Katsilambros N, Giamarellou H: Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia. Clin Infect Dis. 2001, 32: 1718-1728. 10.1086/320744.CrossRefPubMed
8.
go back to reference Al-Nawas B, Shah PM: Procalcitonin in patients with and without immunosuppression and sepsis. Infection. 1996, 24: 434-436. 10.1007/BF01713044.CrossRefPubMed Al-Nawas B, Shah PM: Procalcitonin in patients with and without immunosuppression and sepsis. Infection. 1996, 24: 434-436. 10.1007/BF01713044.CrossRefPubMed
9.
go back to reference Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bouhon C: High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993, 341: 515-8. 10.1016/0140-6736(93)90277-N.CrossRefPubMed Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bouhon C: High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993, 341: 515-8. 10.1016/0140-6736(93)90277-N.CrossRefPubMed
10.
go back to reference Gendrel D, Raymond J, Assicot M: Procalcitonine, protéine C-réactive et interleukine 6 dans les méningites bactériennes et virales de l'infant. Presse Med. 1998, 27: 1135-9.PubMed Gendrel D, Raymond J, Assicot M: Procalcitonine, protéine C-réactive et interleukine 6 dans les méningites bactériennes et virales de l'infant. Presse Med. 1998, 27: 1135-9.PubMed
11.
go back to reference Whang KT, Steinwald PM, White JC, Nylen ES, Snider RH, Simon GL: Serum procalcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab. 1998, 83: 3296-3301. 10.1210/jc.83.9.3296.PubMed Whang KT, Steinwald PM, White JC, Nylen ES, Snider RH, Simon GL: Serum procalcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab. 1998, 83: 3296-3301. 10.1210/jc.83.9.3296.PubMed
12.
go back to reference Giamarellou H, Giamarellos-Bourboulis EJ, Repoussis P, Galani L, Anagnostopoulos N, Grecka P, Lubos D, Aoun M, Athanassiou K, Bouza E, Devigili E, Krçmery V, Menichetti F, Panaretou E, Papageorgiou E, Plachouras D: Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study. Clin Microbiol and Infect. 2004, 10 (7): 628-633. 10.1111/j.1469-0691.2004.00883.x.CrossRef Giamarellou H, Giamarellos-Bourboulis EJ, Repoussis P, Galani L, Anagnostopoulos N, Grecka P, Lubos D, Aoun M, Athanassiou K, Bouza E, Devigili E, Krçmery V, Menichetti F, Panaretou E, Papageorgiou E, Plachouras D: Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study. Clin Microbiol and Infect. 2004, 10 (7): 628-633. 10.1111/j.1469-0691.2004.00883.x.CrossRef
13.
go back to reference Horan TC, Gaynes RP: Surveillance of nosocomial infections. Hospital Epidemiology and Infection Control. Edited by: Mayhall CG. 2004, Philadelphia: Lippincott Williams & Wilkins, 1659-1702. 3 Horan TC, Gaynes RP: Surveillance of nosocomial infections. Hospital Epidemiology and Infection Control. Edited by: Mayhall CG. 2004, Philadelphia: Lippincott Williams & Wilkins, 1659-1702. 3
14.
go back to reference ACCP/SCCM criteria-1992: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions fro sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992, 20: 864-874.CrossRef ACCP/SCCM criteria-1992: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions fro sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992, 20: 864-874.CrossRef
15.
go back to reference Giamarellou H: Infections in febrile neutropenia. Infectious diseases in critical care medicine. 1998, New York:Marcel Dekker, 563-598. Giamarellou H: Infections in febrile neutropenia. Infectious diseases in critical care medicine. 1998, New York:Marcel Dekker, 563-598.
16.
go back to reference Hulley SP, eds: Designing Clinical Research. 2001, Philadelphia, USA by Lippincott Williams & Wilkins, 2 Hulley SP, eds: Designing Clinical Research. 2001, Philadelphia, USA by Lippincott Williams & Wilkins, 2
17.
go back to reference Dawson B, Trapp RG: Basic & Clinical Biostatistics. 2001, New York, Lange Medical Books/Mc Graw-Hill, 3 Dawson B, Trapp RG: Basic & Clinical Biostatistics. 2001, New York, Lange Medical Books/Mc Graw-Hill, 3
18.
go back to reference Oberhoffer M, Stonans I, Russwurm S: Procalcitonin expression in human peripheral mononuclear cells and its modulation by lipopolyssacharides and sepsis-related cytokines in vitro. J Lab Clin Med. 1999, 134: 49-55. 10.1016/S0022-2143(99)90053-7.CrossRefPubMed Oberhoffer M, Stonans I, Russwurm S: Procalcitonin expression in human peripheral mononuclear cells and its modulation by lipopolyssacharides and sepsis-related cytokines in vitro. J Lab Clin Med. 1999, 134: 49-55. 10.1016/S0022-2143(99)90053-7.CrossRefPubMed
19.
go back to reference Ruokonen E, Nousianen T, Pulkki K, Takala J: Procalcitonin concentrations in patients with neutropenic fever. Eur J Clin Microbiol Dis. 1999, 18: 283-285. 10.1007/s100960050277.CrossRef Ruokonen E, Nousianen T, Pulkki K, Takala J: Procalcitonin concentrations in patients with neutropenic fever. Eur J Clin Microbiol Dis. 1999, 18: 283-285. 10.1007/s100960050277.CrossRef
20.
go back to reference Fleischhack G, Kambeck I, Cipic D, Hasan C, Bode U: Procalcitonin in paediatric cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumor necrosis factor receptor II. Br J Haematol. 2000, 111: 1093-1102. 10.1046/j.1365-2141.2000.02458.x.CrossRefPubMed Fleischhack G, Kambeck I, Cipic D, Hasan C, Bode U: Procalcitonin in paediatric cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumor necrosis factor receptor II. Br J Haematol. 2000, 111: 1093-1102. 10.1046/j.1365-2141.2000.02458.x.CrossRefPubMed
21.
go back to reference Engel A, Steinbach G, Kern P, Kernn WV: Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis. 1999, 31: 185-9. 10.1080/003655499750006254.CrossRefPubMed Engel A, Steinbach G, Kern P, Kernn WV: Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis. 1999, 31: 185-9. 10.1080/003655499750006254.CrossRefPubMed
22.
go back to reference Sudhoff T, Giagounnidis A, Karthaus M: Serum and plasma parameters in clinical evaluation of neutropenic fever. Antibiot Chemother. 2000, 50: 10-19.CrossRefPubMed Sudhoff T, Giagounnidis A, Karthaus M: Serum and plasma parameters in clinical evaluation of neutropenic fever. Antibiot Chemother. 2000, 50: 10-19.CrossRefPubMed
23.
go back to reference Schuttrumpf S, Binder L, Hagemann T, Berkovic D, Trumper L, Binder C: Utility of procalcitonin concentration in the evaluation of patients with malignant diseases and elevated C-reactive protein plasma concentrations. Clin Infect Dis. 2006, 43 (4): 468-73. 10.1086/505394.CrossRefPubMed Schuttrumpf S, Binder L, Hagemann T, Berkovic D, Trumper L, Binder C: Utility of procalcitonin concentration in the evaluation of patients with malignant diseases and elevated C-reactive protein plasma concentrations. Clin Infect Dis. 2006, 43 (4): 468-73. 10.1086/505394.CrossRefPubMed
24.
go back to reference Giamarellos-Bourboulis EJ, Mega A, Grecka P: Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient?. Intensive Care Med. 2002, 28: 1351-1356. 10.1007/s00134-002-1398-z.CrossRefPubMed Giamarellos-Bourboulis EJ, Mega A, Grecka P: Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient?. Intensive Care Med. 2002, 28: 1351-1356. 10.1007/s00134-002-1398-z.CrossRefPubMed
25.
go back to reference Barnes C, Ignjatovic V, Newall F: Change in serum procalcitonin (delta PCT) predicts the clinical outcome of children admitted with febrile neutropenia. Br J Haematol. 2002, 118: 1197-1198. 10.1046/j.1365-2141.2002.37029.x.CrossRefPubMed Barnes C, Ignjatovic V, Newall F: Change in serum procalcitonin (delta PCT) predicts the clinical outcome of children admitted with febrile neutropenia. Br J Haematol. 2002, 118: 1197-1198. 10.1046/j.1365-2141.2002.37029.x.CrossRefPubMed
26.
go back to reference Secmeer G, Devrim I, Kara A, Ceyhan M, Cengiz B, Kutluk T, Buyukpamukcu M, Yetgin S, Tuncer M, Uludag AK, Tezer H, Yildirim I: Role of procalcitonin and CRP in differentiating a stable from a deteriorating clinical course in pediatric febrile neutropenia. J Pediatr Hematol Oncol. 2007, 29: 107-11. 10.1097/MPH.0b013e3180320b5b.CrossRefPubMed Secmeer G, Devrim I, Kara A, Ceyhan M, Cengiz B, Kutluk T, Buyukpamukcu M, Yetgin S, Tuncer M, Uludag AK, Tezer H, Yildirim I: Role of procalcitonin and CRP in differentiating a stable from a deteriorating clinical course in pediatric febrile neutropenia. J Pediatr Hematol Oncol. 2007, 29: 107-11. 10.1097/MPH.0b013e3180320b5b.CrossRefPubMed
Metadata
Title
Procalcitonin (PCT) and C-reactive Protein (CRP) as severe systemic infection markers in febrile neutropenic adults
Authors
Karin SR Massaro
Silvia F Costa
Claudio Leone
Dalton AF Chamone
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2007
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-7-137

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