Predictive factors of bacteraemia in low-risk patients with febrile neutropenia

Abstract

PCT, tachypnoea and PS were predictive of bacteraemia in the low-risk patients with FN. If the patient has high probability of bacteraemia, the patient could benefit from parenteral antibiotic treatment while awaiting the blood culture results.

Procalcitonin as a marker of infection in febrile neutropenia: A systematic review

“…The 9 included studies are presented in Table 1 with the relevant data extracted [19][20][21][22][23][24][25][26][27]. Overall, a total of 1.498 episodes of FN in 1.396 patients were available for qualitative analysis.…”

“…The remaining included a mixed onco-hematological population. The measured outcomes were in most cases either microbiologically (MDI) or clinically documented infection (CDI), three studies only had the presence of bacteremia as an endpoint [21,25,27]. Regarding the diagnostic accuracy of PCT, the sensitivity ranged from 42% to 72% and the specificity ranged from 64% -89%.…”

“…Few data regarding PCT and systemic mycosis are available from the included trials, 5 cases of fungemia are reported by Giamarellou et al [23] and a low level of PCT occurred in all patients. PCT has been examined as a marker of the severity of the infectious episode and data are presented in three stu- dies [21,23,25]. Giamarellos-Bourboulis et al [21] found significant higher levels of PCT in patients with severe sepsis (defined as sepsis associated with organ dysfunction) compared to patients with a localized clinical infection.…”

“…In diagnostic accuracy tests it might overestimate test performance if the cut-off value is selected to optimize sensitivity or specificity [18]. Two studies [25,27] fail to report the laboratory technique for PCT measurement while the remaining used a quantitative immunoassay and the chosen cut off values ranged from 0.5 -0.8 ng/mL.…”

“…Our results indicate that PCT has a relatively high specificity ranging from 64% -89% but only an intermediate sensitivity ranging from 42% -72% at a threshold of 0.5 -0.8 ng/mL, thus suggesting a potential role for PCT as a more specific biomarker and supplementing the current approach to FN. Four of the included studies compare the diagnostic value of PCT to CRP and all found PCT to be superior to CRP [23][24][25]27].…”