Cancer patients with fever and neutropenia currently are assessed
on clinical grounds only. The current study prospectively evaluated the efficacy of
baseline procalcitonin (PCT) in the detection of bacteremia and in the prediction
of outcome in patients with solid tumors and febrile neutropenia.
METHODS. PCT levels were determined at baseline and every 48 hours in 104
patients undergoing chemotherapy who developed fever (axillary temperature
38 °C on 2 occasions or 38.3 °C in a single record) and neutropenia (absolute
neutrophil count 500 cells/ L).
RESULTS. The median baseline PCT values were significantly higher in patients
who had microbiologically documented infections (1.24 ng/mL) compared with
patients who had clinically documented infections (0.27 ng/mL) or fever of unknown
origin (0.21 ng/mL; P 0.01). Accordingly, a PCT cut-off value of 0.5 ng/mL
was reached more frequently in patients who had microbiologically documented
infections compared with patients who had clinically documented infections or
fever of unknown origin (66.7% vs. 13.4%, respectively; P 0.001). Furthermore,
this threshold also was associated with an increased likelihood of treatment failure
(70.0% vs. 14.9%; P 0.001). All 4 septic patients and all 5 patients who ultimately
died presented PCT values 5-fold to 10-fold greater than the median values.
Clinical evaluation in combination with baseline PCT assessment appeared to
improve clinical risk evaluation alone.
CONCLUSIONS. Baseline PCT levels were higher in patients who had febrile neutropenia
with bacteremia compared with patients who had clinical infections or
fever of unknown origin. PCT helped to identify patients who had microbiologic
infections and patients who were at high risk of treatment failure, and PCT may
constitute a complementary tool in the initial assessment of such patie
